The need for a more transparent and accountable method of assessment for medical practitioners in the UK has engendered interest in a number of novel assessment techniques. Perhaps the most controversial and widely applicable is the ‘360 degree’ technique.
As a profession medicine has a tradition of informal and internal self-regulation. This has naturally led to mistrust of methods of rating individual performance. Against this background of reticence and suspicion any method of assessment must gain the trust of doctors from a wide range of disparate disciplines whilst being demonstrably fair and linked to existing professional control mechanisms. Additionally there must be agreement about the overall purpose of the assessment, the questions asked and limits on publication of results.
So far in the UK undergraduate education has been the first to adopt 360 degree assessment within the guise of a wider attempt to teach personal and professional development. Generally students have welcomed the opportunity to receive impartial feedback. The concerns regarding 360 degree assessment tend to surround two broad areas. There are numerous practical issues regarding implementation and interpretation of results and broader psychosocial issues regarding the applicability of one semi-quantitative tool to disparate personality types. Sufficient resources must be given to support performance following feedback and key individuals within an organization must be enthusiastic about the process and supportive both in terms of time and resource allocation. The data collection process must be user-friendly to encourage participation and thought must be given to the integration of results within existing management systems. Finally such evaluation should never be a static, one-off process but rather be ongoing and form part of multi-faceted continuing professional development. There is a paucity of research into the effect of multi-rater feedback on professional development. What is certain however is that personality type determines ones response to external critique with introverted personalities tending to reflect more constructively than extroverts. No one form of assessment can deliver uniform increases in productivity without risking a negative response.
There is of course another price to pay for assessment- a financial cost. It is estimated that a large UK hospital trust could expect an initial cost of £500,000 with annual expenditure of around £200,000 to launch an industry standard multi-rater feedback performance programme- for its consultant staff alone. The price of a poorly conceived and disruptive attempt in terms of staff morale could be far higher.
Medicine needs more sophisticated performance evaluation techniques and can exist without public scrutiny no longer. If multi-rater or 360 degree feedback is to succeed, experience tells us that the emphasis must be on training individuals involved fully, and providing comprehensive and well integrated support following the exercise so that participants feel empowered not undervalued. Such systems may ultimately prove too unwieldy for use with the bureaucratic constraints of the modern NHS. If used for staff development rather than career advancement medicine may benefit from a degree of reflection perhaps lacking in recent years.