Next steps

Offer
process
Appeals
Onboarding
Final
evaluation

Offer process

Once the Selection Committee has made its final decision on its suitable candidates, the process of offering the positions begins.

Most online recruitment systems will generate offers in bulk, which are then sent out to successful candidates. At the same time, a notice may be sent to unsuccessful candidates. Selection committees may wish to avoid doing the latter for a few days in case some offers are declined.

In large recruitment activities it is inevitable that some candidates may decline an offer as they have received and accepted an offer from another training network/setting. This is where it is useful to have a predetermined eligibility list from which other candidates can be made an offer. In this process, the committee provides feedback to candidates on their eligibility status and potential to receive an offer should another candidate decline. While this method is helpful in retaining the committee's preferred candidates, it is imperative to keep the recruitment process going so that candidates can consider other offers of employment if their first choice is not available. Eventually eligibility lists are exhausted or expire – most jurisdictions place a time limit on how long someone can be on an eligibility list before requiring to apply again.

At this point there may still be vacant positions which training settings/networks will likely be keen to see filled. Ideally, the Committee would recommence the recruitment and selection process. This can be a simple option for programs which have smaller numbers of applicants and positions and fewer people involved in the selection process. For larger networks and programs, where recruitment and selection can be lengthy, it isn't feasible to restart the recruitment and selection process.

Appeals

Training settings and networks should have a process to receive, and investigate if necessary, information that alleges improper behaviour of candidates and/or selection committee members.

Unsuccessful candidates may want to appeal or request a review of the selection process. How this occurs is generally determined by training setting/network local policy. It's best to seek advice from your human resources department as soon as an appeal lodged.

Complaints or appeals against processes and/or decisions made are more likely to be dealt with efficiently if the selection process espouses the RACP principles of rigour and fairness, and has been well documented.

Deadlines to enter or continue in a training program must be strictly followed to avoid disappointment, as well as the RACP eligibility requirements.

Process handling

To reduce the likelihood of an appeal or complaint, Selection Committees should ensure that they:

have a proper documentation process and that good documentation is kept at all times
review their processes with human resources or an equivalent
are aware of their responsibilities under law and policies, and stay up to date on relevant employer and RACP policy requirements
undertake appropriate training and keep open lines of communication
are aware of types of questions which shouldn't be asked during an interview
manage potential conflicts of interest with known candidates
avoid advantaging certain candidates, for example by offering a pre-meet
have a process for managing complaints and requests for reconsideration or review of decisions, that's managed in conjunction with human resources or medical workforce unit at the training setting/network
seek advice from a human resources expert at their training setting/network when in doubt
liaise with other Selection Committee members regularly
discuss how potential problems should be resolved in readiness should a case occurs

Clear criteria is needed when determining whether a candidate is eligible for appeal and be assessed using establish processes. It is important that information about all applicants is accurate and valid³. This can be a particular point of tension between candidates who are external to the hospital or training program, and who are competing against other candidates that are already present and known within the hospital or training program.

Providing transparency in both the selection process and information to candidates can help reduce concerns. Consider making the selection process transparent as much as possible through making information available in a public and accessible way. This may include how each tool (applications, CVs, references or interviews) are used and how each is individually considered and weighted. Candidates can be given the names and general profiles of the members of the interview panel beforehand. Information about how the Selection Committee are trained to perform their role can also be provided.

The University of Toronto recommends the following four measures for transparency⁴:
Measures of Transparency infographic

³ Sklar D. Who’s the fairest of them all? Meeting the challenges of medical student and resident selection. Academic Medicine. 2016;91(11):1465-1467.
⁴ Postgraduate Medical Education, University of Toronto. Best Practices in Applications & Selection [Internet] Toronto: University of Toronto; 2013.

Onboarding

Onboarding, also known as induction or extended orientation, is a process that facilitates a new medical trainee’s adjustment into their role and organisation. Effective onboarding is an investment in employee morale, productivity and retention. This in turn is likely to reduce financial costs through increased productivity and reduced need to re-recruit.

Most hospitals will have an orientation program. It is also common, and best practice, that new trainees are provided with an orientation of the local training program and ongoing support.

Best practice based upon findings in the public sector industry suggests these principles to employers for effective onboarding⁵:

Conduct a structured induction process that covers work and administrative matters, for example how consults are requested or how to check your payslip.
Use a buddy system.
Obtain formal feedback from new trainees once a sufficient amount of time has past.
Monitor and manage any and all probationary periods.

The buddy system is a tool that can be particularly helpful in supporting new trainees by providing them with guidance and information to assist their transition. It is also an opportunity for the assigned buddy to directly and positively impact a new trainees' experience in the training program. The potential benefits of the buddy system include faster integration of new trainees into the culture and processes, and increased trainee satisfaction and morale.

The assigned buddy should be an existing trainee who has enough organisational experience as well as an interest in supporting the new trainee through their initial phase of their employment.

Buddy system example

Case study: Royal Children's Hospital Melbourne – Paediatrics & Child Health

At the Royal Children’s Hospital (RCH) in Melbourne, an onboarding program and an opt-in mentoring system exists where interested Advanced Trainees, who wish to be a mentor, make a video for the new trainees to watch. After watching the videos, new trainees can choose who they wish to mentor them.

The approach to the intake of Basic Trainees is to give them a sense of service and of being a part of the cohort. On two evenings in January, events are held with a mix of information about the details of their first job, a question and answer session about RACP training and other information, along with pizza. There is targeted mingling with new trainees as well as with trainees in the year above. Participants are also given an information pack.

Some of the common 'pain points' for Basic Trainees in their first few weeks are IT related, so RCH aims to give all trainees their passwords in advance. Trainees are rostered for training in the electronic medical record system before they start and paid for this training time upon commencement.

Case study: Waitemata District Health Board, New Zealand – Adult Internal Medicine

At Waitemata District Health Board (DHB), an orientation program runs every six months for all general and subspecialty medical registrars in Adult Internal Medicine whether they're new to the District Health Board or just new to their role.

The focus of the orientation is an introduction to 'how medicine works' at the two main hospitals in the DHB and a hands-on session about how common procedures are performed in the DHB.

The Director of Physician Education or Educational Supervisors meet with all new Basic Trainees shortly after they have applied to the RACP. A strong collegial culture exists within the General Medicine department whereby more senior trainees provide support to junior trainees.

⁵ State Services Authority. Best practice recruitment selection methodology and tools. Melbourne: Victorian Government; 2007.

Final evaluation

The point between training position offers, contracts and commencing of the onboarding program provides an opportunity for a final evaluation of the outcome of recruitment and selection process.

Within your documentation you will have collected a wealth of information about the types and characteristics of successful and unsuccessful candidates. Chairs should have received feedback from their Selection Committee members and possibly candidates as well.

There is a wealth of material and information you may also be able to pull from other sources, including the human resources department and medical workforce and training units.

Improving the recruitment process

The recruitment process

Analyse scores on individual aspects of selection, for example CVs vs referee reports, individual interview stations, or scores between various selection criteria, as these may provide some vital clues as to what parts of the process are more discriminatory and are potentially helpful in making future decisions.

Take a look at the characteristics of any trainees who declined an offer.

Keep trend data over several years. For example the total number of applicants, the number of applicants according to demographics versus positions, and the number of internal candidates versus external candidates. If the proportion of candidates to positions is trending upwards, this is generally a positive sign. If the trend is going downwards, you may need to concentrate your efforts towards advertising and promoting available positions.

At this stage, examining the local pipeline, such as the number of internal candidates applying, may make sense as it is generally easier to market training positions to medical trainees already within your reach.

Human Resources or Medical Workforce Unit

Gather information about the number of trainees who resigned early, particularly in the first six months, and track this back to see if there was any indication of this outcome during the selection process. All employees who resign should be offered an exit interview or exit survey. Human Resources can compile results of these interviews or surveys.

Training program

Try to match the ranking scores of candidates to their training performance.