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Selection and recruitment in Healthcare in the time of COVID – what have we learned and where next?

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The COVID pandemic has disrupted university selection processes around the world. At a time when healthcare workers are more vital than ever, how do we take what we’ve learnt during 2020 and ensure that the methods used in Medical selection remain valid, fair and reliable in a post COVID landscape? This was the topic for discussion at this year’s meeting of the International Network for Researchers in Selection into Healthcare (INReSH). 

What is INReSH ?

INReSHis the brainchild of WPG’s founding partner, Fiona Patterson. It was established in 2014 by the Medical Schools Council (MSC) and the Association for the Study of Medical Education (ASME). The network meets every year. Usually this is alongside an international conference in healthcare education. Meetings focus on how strategic and societal challenges shape selection practices, and how this determines avenues of future research. 

INReSH 2020 

This online event was attended by an international audience of around 65 undergraduate and postgraduate members of medical education. There were two keynote speakers and three workshops that enabled the audience to exchange ideas and share best practices. 

How COVID-19 could push selection research to where it should have been all along 

Our first keynote speaker was Dr Kevin EvaProfessor and Director of Education Research and Scholarship at The University of British Columbia and Editor of Medical Education.

Dr Eva acknowledged that COVID has forced medical selection to try alternative selection procedures. But emphasised the need to ensure that research in this space provides long-term impact/relevance.  

This means making sure it is relatable and transferable to as wide an audience as possible and not just suitable for our own institutions.  Dr Eva suggested that we ‘embrace our inner child’ by focusing on the why/clarifying questions to make sure we get that wider relevance.  

Reflections

After the speech, participants workshopped the priorities for research within medical selection. An insightful reflection was shared early on in the discussion: Everything has changed, but nothing has changed. Whilst we have had to adapt our selection processes during COVID times, the issues that we face in selection (validity, reliability, applicant perceptions) remain the samejust presented differently The pandemic is forcing researchers in this space to evaluate selection processes from a different perspective 

The group found it useful to unpick the differences in how each nation is exploring the effects of recruitment during COVID.  It was agreed as a starting point, all nations should investigate the impact of COVID on the population that was attracted to recruitment in medicine. Alternative processes (potentially regarded as easier to complete) may have attracted different population thaprevious years. For example, digital selection methods do not require travel. And changes to the grading system in that predicted grades might have impacted students’ opportunities if they are higher or lower than what would have been achieved 

Gaining this understanding might influence future research into the impact of selection processes on the workforce/cohort selected, informing the choice of selection methods in the future.  

The impact of COVID on Widening Participation  

Widening participation (WP) is a government initiative offering opportunities to groups of people who are under-represented in higher education.   

In the UK, being a doctor or working in medicine has traditionally been considered a career for the more privileged.  Despite efforts to increase gender parity and ethnic diversitythe lack of people from lower socio-economic backgrounds entering the profession is still an issue.   

It’s important we encourage everyone with the potential to study medicine to regard it as a viable option, irrespective of their socio-economic circumstances.  And, by supporting widening participation in medicine, we are also ensuring that the NHS is reflective and understanding of the needs of its patients in the future. 

Research into COVID-19 on school children

Professor Anna Mountford-Zimdars, Professor of Social Mobility and Director of the Centre for Social Mobility at the University of Exeter, shared her quick research into the impact of COVID on school children.  She found many differences in what they had missed when schools were closed based on their Socioeconomic Status (SES).  For example, those from a lower SES were more inclined to miss the environment itself. Perhaps because it was harder for them to replicate that at home.  Where children from a higher SES might pine for a particular teacher but may generally have better access to tutors, IT, etc.. 

In terms of medical selection, Professor Mountford-Zimdars said she would like to see further interrogation of why we use the established selection criteria and more consideration of what we are selecting for.  For example, we referred earlier to the use of a blanket standard for academic criteria.  But is academic excellence across all subjects an absolute requirement for medical selection?  Or by using this as a first measure are we excluding people from disadvantaged groups where access to extracurricular support and/or tutoring to top marks in all subjects was not available? 

Workshops

follow up workshop allowed for a wider discussion around the topic.  In terms of widening participation, there are some considerations that have come out of the changes to medical selection forced upon us by the pandemic.  Applicants have reported finding the interview experience less stressful when it’s managed remotely and more manageable financially with the need for travel removed.  But this is perhaps outweighed by WP students who struggled with access to technology and with education generally during lockdown.  In addition, it was more difficult to get a feel for the medical school. Or to meet student ambassadors and to access work experience opportunities. 

The learnings

In terms of learnings, participants felt that, post COVID, it would be worthwhile to a run a mix of online and real-life open days and student Q&As.  Students could perhaps also be allowed to submit information about extenuating circumstances based on the impact of COVID.  In this regard, MSC already tries to reduce the emphasis on ‘number of hours’ work experience. But there is still work to be done in communicating this to applicants as research suggests that their perception hasn’t necessarily changed​. 

There was also general discussion around digital selection, the changes that have occurred during the pandemic, the benefits and disadvantages of these and what our preferred options might be going forward. The consensus seemed to be that COVID has forced many settings to make changes to their selection processes and that this offers us an opportunity to consider the lasting impacts – the worthwhile changes and those that need more research before we adopt them permanently. 

In terms of feedback on the INReSH event itself, many participants said that they liked having the opportunity to contribute to and benefit from this valuable collaboration without having to get on a plane!  

There’s more information about INReSH here.  And you can view the conference here

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