Concerns with recruitment for 2021 start

COVID-19 has once again disrupted the plans for recruitment for 2021, with concerns around the second surge of the pandemic leading to significant changes to what was expected for upcoming recruitment plans.

The 2021 medical and dental recruitment and selection plans that will affect all trainees in the four-nations of the UK were revealed at a webinar on 21 October, detailing an increased use of the Multi-Specialty Recruitment Assessment (MSRA), as well as many fewer specialties running interviews, and some continuing to use unverified self-assessment.

Meetings to determine an approach for 2021 recruitment began during summer 2020, to ensure that the upcoming recruitment process remained resilient to the challenges of COVID-19. The BMA was in attendance throughout, to ensure that learning was taken forward from issues in the 2020 recruitment process, but also to advocate for processes that were truly trainee-centred.

The BMA raised concerns throughout deliberations on the new proposals that have been suggested by recruitment teams, but also offered a positive vision of how recruitment could be delivered in the midst of COVID-19, and attended meetings throughout the pandemic on recruitment issues.

The BMA’s concerns were echoed by the Academy of Medical Royal Colleges training reps, who also attended these meetings for new proposals.

Our concerns with these proposals

When 2020 recruitment proposals were disrupted due to the initial wave of the pandemic, this led to a significant change in recruitment methodology for those applying at that time. The BMA had significant concerns about the final process, but it was crucial that recruitment went ahead for trainee career, training and pay progression.

Since then we have heard loud and clear from our membership that you were unhappy with the lack of clear communication, stronger focus on exams, unverified self-scoring, and lack of interviews. Consistent concerns were raised with us about the equality impacts of such proposals – we have continued to represent those concerns to recruiters through this year and the planning for subsequent recruitments

For 2021 recruitment, preparations have been made earlier in order to give more opportunity for issues to be resolved as early as possible, with agreement from all participants. However, the BMA and other trainee representatives’ concerns have been left resoundingly unresolved, resulting in a process that the BMA is concerned that this will lead to a repeat of issues and concerns that arose as a result of the changes to the 2020 recruitment process.

The proposed changes fail to appreciate the impact of both these recruitment processes, and the current pandemic on applicants. The combination of these two issues puts increased strain on these trainees when trying to prepare for their recruitment, while also managing heavy clinical workloads.

The BMA’s issues with the process are:

• The MSRA is not designed for, validated in, or tailored to, many specialties where its usage is now being proposed. Validation is currently limited to General Practice, Psychiatry and Radiology, where it is validated as part of normal recruitment processes and not as a stand-alone assessment.
• Applicants will have to study for yet another exam, increasing the burden of assessment on them, during a time when stress is already high due to the impact of the pandemic.
• There is currently a lack of clarity regarding how those who require reasonable adjustments will receive these.
• Timelines have shifted forwards by a significant amount, with little to no prior warning. This has led to a changing of the goal posts, and moving highly pressured recruitment into peak winter pressures alongside the anticipated second COVID peak.
• Some specialties continue to use unverified self-assessment scoring, and the equality impact assessment on this methodology has not yet been published from the last round.
• Self-assessment appeals in 2020 were as short as 48 hours for appeals, which is far too short for a reasoned and fair appeal for those on the most challenging rotas.

The BMA’s position is against the use of the MSRA by new specialties without the evidence to validate and underpin its use, and without warning during the pandemic. The BMA and other trainee representatives have consistently voice concerns with this, and voted against its use.

What we envisage for an alternative COVID recruitment process

Firstly, any new process must be informed by the Equality Impact Assessment (EIA) that was completed during the summer of 2020 and any new recruitment methods should also be subject to an EIA before changes are implemented. This means that the EIA must be published for public consumption.

The BMA’s position is that it is possible to deliver consultant-led interviews virtually, either with one or two consultants present, plus a lay person. We believe that this is possible to deliver, even when considering current service demands. We also know that this is the method that our members tell us that they prefer, regardless of their background or protected characteristics.

We have also been supportive of the need to develop contingency plans, however the contingency plans that have been suggested do nothing to reduce the pressures on applicants.

The BMA is cognisant of reducing time and resource demands on education structures, administrative teams and senior colleagues – however, adding in exams increases the amount of time that applicants will have to sacrifice in order to properly prepare.

This is in addition to the time commitment of the process itself, and shifts the time burden onto applicants in a way that we find unacceptable.

What has the BMA been doing?

The BMA went into discussions with a clear vision of a process that was delivered virtually, with interviews and direct opportunities for trainees to.

We understand pressures on the service and consultant time, but offered a proposal that respected these pressures while allowing trainees the opportunity to have an interview with a consultant in the specialty of their choice.

We have been working with other trainee organisations, including the Academy of Medical Royal Colleges’ Trainee Doctor group, to develop a clear trainee voice. This meant that trainees spoke consistently together about the concerns with the process, and our alternative proposals.

How do I raise a concern with the BMA?

If you are concerned about the effect of the changes by recruitment teams, then make sure to raise them with your regional RDC rep, or email [email protected].

BMA keys asks and principles

BMA asks:

• trainees are still able to access the 4th nodal pay point – important for those who would be applying to an ST3 post who would be expecting a pay rise if appointed
• career progression is protected so that total career earnings would be unaffected for as many as possible
• there should be no increase in the burden of assessment or process for trainees – such as complex new assessments or form filling
• applicants should be updated as soon as possible with regular communications from HEE regarding decisions including rationale
• all agreed processes are transparent.

Core principles agreed:

• all recruitment processes should recruit to full length training programmes, not just 12 month LAT (Locum Appointment for Training) posts
• no recruitment process should increase the burden of assessment on trainees
• no recruitment process should use an exam for trainee selection if they were not already expecting to sit one
• all recruitment contingencies should be agreed with the worst case scenario of COVID in mind
• all recruitment processes should be transparent in their selection.

Concerns with recruitment for 2020 start

Recruitment must go ahead this year

Despite some suggestions that recruitment be cancelled this year, we disagreed with this for the following reasons:

• it could leave a number of doctors without employment
• a number of specialties were proposing curriculum changes after this recruitment round – no recruitment could have shut some out of the training pathways due to these changes
• preventing applicants from entering ST3 would prevent some accessing the 4th nodal pay point and lead to a significant drop in expected earnings
• HEE were not keen to prevent recruitment as it would cause a reduction in CCT numbers in years down the line
• it may have exacerbated a bottle neck in recruitment next year, with possibly twice the number of trainees applying. This would hugely increase competition ratios, with a knock on for capacity for some units of training also.

Video conference interviews were not possible

Taking into account the capacity of senior clinicians time under a projected worst case scenario due to COVID-19, at the time when these decisions were made in early spring and the course of the pandemic was an unknown, video interviews were felt to be unworkable.

Other factors associated with this that presented as a potential problem, included:

• time scales to allocate the slots for Skype interviews would have been short (one to two weeks) giving little notice to applicants at a time when rotas were extremely fluid
• a high risk of trainees not being able to attend their interview slot due to rapidly changing COVID rotas, illness or short notice notification.

No recruitment to LATs

It was agreed that there was no benefit to either trainees or the system of recruiting solely to LAT.

All recruitment would be done to full programmes with assurance of robust supervision and enhanced ARCP (Annual Review of Competency Progression) process in 2021 to ensure that trainees were progressing well and prepared to move forwards to ST4.

This decision was made because:

• ARCP functions as a mechanism to monitor progression to the next stage of training, and that applicants’ previous ARCPs would have highlighted concerns and any emerging concerns could be picked up at the subsequent ARCP and actioned for additional support
• the recruitment process would be the same regardless of whether you appointed to LAT or full programme; you would also still be appointing the same people for the first 12 months
• the only difference to the system would be that after 12 months everyone, regardless of whether they had progressed satisfactorily or not, would need to reapply. This would be along with the next cohort of applicants.

Validation of self-scores

Specialties validating scores

Most specialities request trainees to self-score at the time of application, meaning applicants should have self-scored expecting to have to evidence their decisions.

It was argued by the BMA that applicants would have acted with professionalism and honesty in this process and it was agreed that these scores could be taken at face value.

There has not been data provided by HEE on what percentage of self scores are reduced/increased on the day of interview.

General surgery, vascular surgery and clinical oncology do not complete self-scoring until later in the process. These applicants later self-scored in the full knowledge that this would be their only source of discrimination in job rankings.

It was recognised that this could affect applicant behaviour (whether consciously or subconsciously) when scoring and that therefore some validation would be needed.

Due to time pressures, and the need to ensure that the process was sustainable to completion it was agreed that 10% of scores from the top of the ranking, 10% from the bottom and 10% from the middle would be selected to be validated.

The BMA raised significant concerns throughout these discussions about the effects of such a proposal for applicants with protected characteristics, such as gender, race, age, and other characteristics protected under the Equality Act.

We remain concerned about the impacts of this recruitment exercise on trainees with protected characteristics, and have requested detailed analysis of the impact of this new process on these groups.

Analysis is being undertaken and should be available in later summer 2020.

Agreement

It was agreed that despite the solution not being ideal, there was no other credible fairer proposal put forward by the involved parties that would have been deliverable.

Candidates validating scores

The ideal position for a number of colleges once video conferencing interviews were ruled out was to have trainees upload evidence for their self-score and all self-scores to be validated, before being used to rank applicants.

However, the following concerns were raised:

• the proposed timeline of one week to upload evidence would not be sufficient for those working nights or long days during the week, without seriously impacting the ability to safely rest
• it would take hundreds of consultant days to go through the material and validate scores, similar to the resource commitment of interviews
• recruiters may get part way through the process and then be unable to continue due to COVID pressures and that recruitment would fail.

Candidates validating their own scores would have been a solution, but it would not have guaranteed equitable recruitment and selection for trainees, so it was not taken forward.

Amending self-scores

There were questions from members as to why they are unable to amend their self score to take into account extra experience or achievements they had gained since they submitted their score at the start of the year.

Trainees in different rotations and areas of the country will have been affected by COVID disruptions at different times and as such some will have had more opportunity to gain extra achievements (and therefore extra points on self-assessment) than others.

This would have the effect of disadvantaging those worst affected by COVID-19, therefore it was agreed that keeping the self-score from January (pre-COVID) was the fairest method of comparison.

Applicants who felt they have accidentally over scored had the ability to adjust this, and communications have gone out to applicants as to how to do this.

Tie-breaks in scores

It was recognised that there will be some trainees with tied scores and the same ranking preferences.

In these situations, Royal Colleges were asked to propose tie breaks based on the self score sections, as was relevant to their speciality.

Medical specialities did some data combing, and identified key domains in the self score that would be used to differentiate between trainees if needed, however different specialties may have chosen different methods.

MSRA (Multi-Specialty Recruitment Assessment)

For GPST1 and Psych CT1, it was agreed that the MSRA would be used as the sole selector, instead of face to face interviews.

The MSRA is usually sat in large-sized group exam settings, however due to COVID, and the requirement to socially distance, this was not possible.

Pearson Vue, who host the tests, have the ability to host online tests in the applicant’s home using remote invigilation via a webcam, and tech-based invigilation solutions.

There is a 3% failure rate of online sittings due to failed internet connection or other tech issues, usually on the applicant’s side.

The reason for using the SJT only was largely due to the time frame and testing capacity. There are time limits for remote invigilation, that could not be met for some applicants that would require reasonable adjustments.

It was suggested that the two sections (AKT and SJT) could be separated and taken independently, however this would have increased the failure rate across the board as both sections are required (think 3% x2), as well as exceeding Pearson Vue capacity.

This would also require more time and rota management from trainees, leaving little time to revise for a clinical assessment, which would be difficult with the COVID pressures on the NHS at the time.

The validity work from Work Psychology Group shows a strong correlation with the MSRA score and achievements at the AKT and final ST3 ARCP, and thus reassured the Royal College of General Practitioners with regards to validity of using this method only during this application round.

Learning for future recruitment rounds

We will continue to state the position on the need for remote interviews with consultants, and to ensure that all recruitment rounds are fair and equitable for all doctors, regardless of their protected characteristics.

We have successfully ensured that the round two recruitment that is upcoming later in 2020 will include Skype interviews for shortlisted applicants, along with inclusion of another member of the recruitment team to help provide assurances on fairness.

We will continue to engage with, and challenge, recruitment teams to ensure that the results are fair and equitable both in this upcoming round, and for all future rounds.

Because of the legacy of COVID-19, as well as the risk of further peaks, we are expecting further disruption to upcoming recruitment rounds for 2021 starters.

We will continue to engage with recruitment teams to make sure that all lessons learned are carried through, and the huge amounts of disruption seen during this year’s recruitment is not repeated.