Developing a facilitation model to promote organisational development in primary care practices

BACKGROUND: The relationship between effective organisation of general practices and health improvement is widely accepted. The Maturity Matrix is an instrument designed to assess organisational development in general practice settings and to stimulate quality improvement. It is undertaken by a practice team with the aid of a facilitator. There is a tradition in the primary care systems in many countries of using practice visitors to educate practice teams about how to improve. However the role of practice visitors as facilitators who enable teams to plan practice-led organisational development using quality improvement instruments is less well understood. The objectives of the study were to develop and explore a facilitation model to support practice teams in stimulating organisational development using a quality improvement instrument called the Maturity Matrix. A qualitative study based on transcript analysis was adopted. METHOD: A model of facilitation was constructed based on a review of relevant literature. Audio tapes of Maturity Matrix assessment sessions with general practices were transcribed and facilitator skills were compared to the model. The sample consisted of two facilitators working with twelve general practices based in UK primary care. RESULTS: The facilitation model suggested that four areas describing eighteen skills were important. The four areas are structuring the session, obtaining consensus, handling group dynamics and enabling team learning. Facilitators effectively employed skills associated with the first three areas, but less able to consistently stimulate team learning. CONCLUSION: This study suggests that facilitators need careful preparation for their role and practices need protected time in order to make best use of practice-led quality improvement instruments. The role of practice visitor as a facilitator is becoming important as the need to engender ownership of the quality improvement process by practices increases

Teachers: Making an objective assessment of a colleague's performance

Background: Historically, assessment of good medical practice has focused on clinical skills and knowledge. However, performance assessments and appraisal today encompasses the review of both non-clinical, or behaviourial skills and the assessment of clinical practice. Context: There is an increasing trend towards the systematic, multifaceted assessment of doctors’ performance. For doctors in training this has facilitated the earlier identification of performance concerns as they arise. Doctors in training have clear goals and accept regular assessments as a requirement of their progression through medicine. This is perhaps not quite the same for more senior colleagues where, for some, the introduction of performance assessments based upon appraisals and revalidation may have historically been uncharted territory. Innovation: Skilful peer assessment is not easy, and the boundaries between roles, responsibilities and relationships when managing senior colleagues can often feel blurred. Performance issues are often complex, multifactorial, and include both clinical and behavioural issues. To make an objective assessment of performance requires a comprehensive understanding of the problems raised. This includes the collection of appropriate detailed information alongside clarity of the local and national processes involved in assessing and managing performance issues. Implications: The provision of local, specific support for more senior colleagues is at present not well formulated. This in turn leads to concerns very often being ignored until they have become a disciplinary issue. With the introduction of revalidation there is a need to address training around the management of performance issues to improve the experience for both the appraiser and the appraisee

Can knowledge tests and situational judgement tests predict selection centre performance?

Objectives  Written tests are an integral part of selection into general practice specialty training in the UK. Evidence supporting their validity and reliability as shortlisting tools has prompted their introduction into the selection processes of other medical specialties. This study explores whether candidate performance on two written tests predicts performance on subsequent workplace-based simulation exercises. Methods  A prospective analysis of candidate performance (n = 135) during the general practice selection process was undertaken. Candidates were shortlisted using their scores on two written tests, a clinical problem-solving test (CPST) and a situational judgement test (SJT). Successful candidates then undertook workplace-based simulation exercises at a selection centre (SC). Scores on the CPST and SJT were correlated with SC scores. Regression analysis was undertaken to explore the predictive validity of the CPST and SJT for SC performance. Results  The data show that the CPST and SJT are predictive of performance in workplace-based simulations (r = 0.598 for the CPST, r = 0.717 for the SJT). The SJT is a better predictor of SC performance than the CPST (R2 = 0.51 versus R2 = 0.35). However, the two tests together provide the greatest degree of predictive ability, accounting for 57% of the variance seen in mean scores across SC exercises. Conclusions  The CPST and SJT play valuable roles in shortlisting and are predictive of performance in workplace-based SC exercises. This study provides evidence for their continued use in selection for general practice training and their expansion to other medical specialties

Do general practice selection scores predict success at MRCGP? An exploratory study

Background: Selection into general practice training is undertaken using a competency based approach. The clear advantage of this approach over traditional methods has been demonstrated through evaluation of its validity and reliability. However, the relationship between selection and performance in the Royal College of General Practitioner examinations (MRCGP) has yet to be explored. The MRCGP comprises of an applied knowledge test (AKT), a clinical skills assessment (CSA) and workplace-based assessments (WPBA). Aim: To explore the predictive validity of general practice selection scores using the AKT and CSA elements of the MRCGP as a final outcome measure. Methods: This study carried out a retrospective analysis of 101 trainees from the Wales Deanery who were successfully selected on to general practice training in 2007. Selection data consisted of an overall selection score as well as scores from each individual stage of selection. Correlation was used to explore associations between selection scores and examination scores. Results: The score for overall performance at selection achieved statistically significant correlation with examination performance (r = 0.491 for the AKT and r = 0.526 for the CSA, P <0.01). Conclusions: The general practice selection process is predictive of future performance in the MRCGP