Use of professional profiles in applications for specialist training positions

In 2000, a specialist commission appointed by the Danish Ministry of Health suggested that postgraduate medical training should be modelled according to the CanMEDS system [1, 2], and a reform to this effect was implemented in 2004. The concept of the system is that the competencies of a medical specialist may be characterised by seven key physician roles and that all roles are equally important. The seven roles were introduced in the form of professional profiles as part of the application process for the Danish specialist training programme in 2008 [3]. The specialist training programmes in Denmark are coordinated by three regional postgraduate medical training secretariats (PMTS). In order to enrol for a specialist training programme, a candidate is required to have finished a one-year introductory specialist position with approved competencies related to the seven roles. Thereafter, a candidate can apply for a specialist training position through one of the regional secretariats. For some of the small specialties, a single secretariat coordinates these activities nationally rather than regionally. An appointment committee evaluates each applicant based on the applicant’s written application, curriculum vitae and an interview, which may range from an informal interview to multiple mini interviews (MMI) [4] based on the seven roles as described by the specialist society. An MMI uses many short independent assessments, typically in a timed circuit, to obtain an aggregate score of each applicant’s competencies. Although a generic template has been developed [3], each of the 38 medical specialties has its own unique professional profile. While professional profiles have now been used to evaluate coming specialists for more than four years, no overall analysis of contents of the profile has yet been presented. Also, experience from the use of professional profiles in appointment committees should be expected to cause at least minor revisions, notably because most of the specialties have application rounds twice a year.

The purpose of this study was therefore to analyse the contents of the professional profiles for each of the 38 Danish medical specialties in relation to:

1. number of roles clearly defined

2. how the roles were ranked by importance

3. whether a standardised score sheet was used for assessment of applicants

4. whether the professional profile had been revised.

Finally, all available profile contents was uploaded to a website with the intent of making a comparison between different specialties easily accessible for career planning physicians and undergraduates [5]. The results should inspire specialties to learn from each other and to tailor the contents of the individual specialty’s professional profile [6].

MATERIAL AND METHODS

In March 2012, the professional profiles and supplemental material were identified for all 38 medical specialties using the website of the PMTS − East. In those cases where material was unavailable from the PMTS − East, the material was extracted from the websites of the PMTS − North or South.

For each specialty, we extracted information on how each of the seven roles was described, how the roles were ranked by importance and the date of the profile. We defined a professional profile as describing a role if the profile had either a separate or a joint category for this role.

We also extracted information on whether standardised score sheets were being used by appointment committees from the secretariats’ websites. We defined a standardised score sheet as a document describing in detail how each of the seven roles should be rated by the appointment committee (e.g. using a scale).

We contacted the secretariats by email for clarification and confirmation of our data and contacted the PMTS − East concerning which professional profiles had been revised and how many times they had been revised.

Finally, the contents of the 38 professional profiles were presented in a content management system (Joomla 2.5, open source), available at www.fagligeprofiler.dk.

The website allows simultaneous comparison of each of the seven roles in the professional profiles for up to four of the 38 specialties.

Trial registration: not relevant.

RESULTS

A total of 24 (63%) of the 38 specialties described the contents for all of the seven roles in their professional profiles, four (11%) described only the contents for some of the roles and ten (26%) described none of the seven roles.

The medical expert and scholar roles were most frequently described and both appeared in 28 (74%) of 38 professional profiles (Figure 1). Each of the other five roles were described in 24 to 26 (63-68%) of the 38 professional profiles. In some of the profiles, individual roles were described in combined categories addressing two to four roles. For example, “pathological anatomy and cytology” had a combined category for the communicator and collaborator roles. Two specialties only described the medical expert and scholar roles (nephrology and psychiatry) and had a third category called “additional roles” which included contents not specifically related to any of the other five roles.

The level of detail of the contents for each role varied between the specialties (Table 1). In some specialties, an approved introductory position was sufficient to fulfil some of the roles (e.g. health advocate in cardilogy). Some roles described contents that was of a quantitative nature and easy for applicants to document (e.g. having worked within the specialty), whereas other contents was of a qualitative nature and more difficult to document (e.g. competency with specific skills).

Nine out of 38 professional profiles (24%) included a clear ranking of the seven roles. The medical expert role was ranked the most important in all nine specialties. In seven specialties, the medical expert role was followed by the scholar role in terms of importance (Table 2).

Seven of 38 specialties (18%) used score sheets, though their use varied among the different PMTSs (Table 3). Two specialties used score sheets only for the interview assessment, and five specialties used score sheets for both assessment of the written applications and for interviews. Five specialties used seven different global score systems which varied in terms of possible maximum scores from seven to 122 depending on the specialty. One specialty (general practice) used a different system in each region.

Four of the 38 specialties (11%) had revised their professional profiles after the initial publication in 2008 (anaesthesiology in 2009; clinical physiology, haematology and general practice in 2010).

DISCUSSION

We found that all seven roles were described in almost two-thirds of the professional profiles. However, the detail of description varied greatly and only nine specialties described how each of the seven roles were ranked by importance. For specialties which did have a description of ranking, the medical expert and the scholar roles were ranked as the most important. Seven specialties used score sheets, of which only six were publicly available.

Strengths and limitations

To our knowledge, this is the first study investigating the usage of professional profiles in Danish postgraduate medical training. We used publicly available data and contacted the PMTSs for confirmation. Since some PMTSs’ websites only disclose professional profile information in the period leading up to an application round, geographic variation may be underreported as some information may have been unavailable at the time we conducted our study. In a similar manner, some of the score sheets were not available from all three PMTS websites. However, our approach was pragmatic and reflects how physicians obtain information in order to plan their career. In order to guide their career choices, physicians need to know which exact criteria are used in the application process and preferably as early as possible.

Furthermore, our definition of roles can be discussed. Some professional profiles used different phrasing, for example clinical oncology used “academic abilities” to describe the scholar role. In those cases, we regarded the professional profile as describing the role. For other professional profiles, some of the roles were less well defined. For example, the profile of nephrology had a category called ’additional roles’ which described information relevant for the three roles of collaborator, communicator and manager. As it was not well-defined for which role for example “positions of trust” was relevant, we did not regard the profile as describing any of the three roles.

Context

In a recent study on the implementation of the seven roles in the specialist courses of the specialist training programmes [7], two specialties did not address the roles at all, 12 only addressed the role of medical expert and none addressed all seven roles. This is corroborated by our findings and suggests a generally poor implementation of the seven roles. Similarly, the implementation of the seven roles in daily clinical practice was addressed in a 2011 survey of Danish physicians [6]. While most physicians in training felt that they had received sufficient training in the roles of medical expert, communicator, collaborator and professional, fewer felt that they were sufficiently trained in the scholar, manager and health advocate roles. The lack of training in the scholar role is interesting as it is ranked to be the second most important role according to the professional profiles.

Definition of roles

The level of detail in the description of individual roles varied considerably between the specialties. There also seemed to be a difference between specialties as to how individual roles were defined. This was most apparent for the professional role. The differences in the definitions of the roles between the specialties were also highlighted in a recent report by the Danish Health and Medicines Authority, which suggests a redefinition of the seven roles, particularly the professional role [6].

Ranking of roles

Only nine profiles ranked the roles by importance, and we know from members of appointment committees that the roles are ranked for some of the other 29 specialties. For example, for gynaecology and obstetrics (East), the medical expert and scholar roles are ranked highest and, although not specified in the profile, this information is made available by the organisation for young gynaecologists and obstetricians and their parent society. Also, the practice of only describing some of the seven roles in professional profiles could be regarded as implicit ranking. Thus, our method may have underestimated the use of ranking. However, and more importantly, this essential information is not publicly available to applicants or in some cases, it is available only in additional material. This is an issue as some applicants may be unaware of how roles are ranked.

Score sheets

Score sheets were used in seven specialties, and five specialties used global scores. In three cases, information on websites did not agree with what was actually being used by appointment committees. The complexity of score sheets differed between specialties from using a single three-point ranking scale for each role during an interview to using an MMI or cumulating a global score for a maximum of up to 122 points. General practice used a different scoring system in each region, and the weight of the interview in the total score ranged from 50% to 83%.

Use of score sheets may be an indirect way of ranking the roles by importance. Thus, in some cases, different maximum scores were used for each role (e.g. in otorhino-laryngology; scholar up to seven points and health advocate up to one point). However, for other specialties (anaesthesiology, orthopaedic surgery and neurology), all roles had a similar weighting of the roles according to their score sheets, while they were ranked differently according to their professional profile.

Furthermore, other committees may use “unofficial” score sheets at their own discretion and available score sheets could be used in a different way than intended. While score sheets give transparency with regard to the criteria by which applicants are assessed, they also introduce several issues. None of the score sheets identified in our study were validated and score sheets may also prevent committees from giving credit to competencies not comprised by the sheets.

Revision of professional profiles

Since professional profiles have received attention in the medical community [8] due to what has been perceived as a less transparent method for selection of specialist candidates, we were surprised to see that only four specialties had revised the original professional profiles. The lack of revised professional profiles may simply reflect that it is clear to members of the specialist appointment committees what each role in the professional profile represents. However, there is a need for a revision of many of the professional profiles in light of the fact that 15 of the professional profiles did not use all seven roles, 29 did not describe how the roles were ranked and 31 did not present information on how they practically assess applicants. As a consequence of the inadequate description of roles, it may be difficult for applicants to target their application and descriptions may be less useful as guides to more long-term career planning [5]. Interestingly, all four of the revised professional profiles included detailed information on all seven roles.

The lack of awareness about the problems characterising some of the profiles may be due to the fact that profiles are developed by the specialist societies, not by the appointment committees. Even though there is some overlap with regard to the people involved in societies and committees, feedback to specialty societies may still be lacking. Even when feedback is adequate, the necessary resources for revision of the professional profiles may be unavailable. Thus, professional profiles are not continuously updated as the needs arise and each medical specialty evolves. Organisations such as the pedagogical development function at the PMTS may help societies with revision of their professional profiles [9].

CONCLUSION

In conclusion, almost two-thirds of the specialties described all seven roles. However, only nine specialties reported how the roles were ranked and just six had publicly available score sheets. Only four professional profiles had been updated since the initial introduction, and we found considerable room for improvement in many of the other profiles. We suggest that specialties seek inspiration for updating of the professional profiles using content from all specialties at fagligeprofiler.dk.

Correspondence: Andreas Lundh, The Nordic Cochrane Centre, Rigshospitalet, 2100 Copenhagen Ø, Denmark. E-mail: al@cochrane.dk

Accepted: 13 April 2013

Conflicts of interest:Disclosure forms provided by the authors are available with the full text of this article at www.danmedj.dk

Acknowledgement: We would like to extend our gratitude to the three regional Postgraduate Medical Training Secretariats for their assistance in obtaining the relevant data.