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Identifying attributes required
by Foundation Year 1 doctors
in multidisciplinary teams: a tool
for performance evaluation
Patricia McGettigan,
1
Jean McKendree,
2
Nick Reed,
3
Sarah Holborow,
2
Charlotte Devereaux Walsh,
2
Thomas Mace
2
▸Additional material is
published online only. To view
please visit the journal online
(http://dx.doi.org/10.1136/bmjqs-
2012-001418).
1
William Harvey Research
Institute, Barts and the London
School of Medicine and
Dentistry, London, UK
2
Hull York Medical School, Hull
and York, UK
3
Centre for Personal Construct
Psychology, University of
Hertfordshire, Hatfield, UK
Correspondence to
Dr Jean McKendree, Hull York
Medical School, Heslington, York
YO10 5DD, UK; jean.
mckendree@hyms.ac.uk
Received 1 August 2012
Revised 17 December 2012
Accepted 19 December 2012
To cite: McGettigan P,
McKendree J, Reed N, et al.
BMJ Qual Saf Published
Online First: [please include
Day Month Year]
doi:10.1136/bmjqs-2012-
001418
ABSTRACT
Background Effective working in
multidisciplinary teams (MDTs) is promoted as
essential in ensuring good healthcare outcomes,
suggesting that an understanding exists of the
relationship between outcomes and the
attributes needed by individuals to function
effectively in the MDT. While the characteristics
of effective teamwork have been described, the
attributes needed by individual MDT members
have not been investigated. To address this, the
study focuses on newly qualified Foundation
Year 1 (FY1) doctors, creating and testing a tool
to evaluate their performance in the MDT.
Methods Repertory grid technique was used to
elicit attributes needed by FY1 doctors to
function effectively in the MDT. Study
participants (all experienced MDT members) used
these to evaluate MDT working by FY1 doctor
colleagues. Data on 57 FY1 doctors were
collected from 95 MDT members working in five
hospitals. Participants also ranked the attributes
in terms of importance for effective team
functioning and rated an ‘Ideal’FY1 doctor.
Results The repertory grid permitted
differentiation between groups of FY1 doctors’
MDT performance. FY1 doctors who undertook
interprofessional training were rated no
differently than UK-trained graduates without
such training. UK-trained graduates were rated
significantly higher on all attributes than non-UK-
trained graduates. Overall, FY1 doctors were
rated lower than the ‘Ideal’. Factor analysis and
rankings suggested tensions between clinical
attributes needed for good team functioning and
more ‘social’attributes.
Conclusions This study demonstrates the
potential of repertory grid methodology in
eliciting attributes that are important for effective
teamworking, and using these to evaluate MDT
working by FY1 doctors.
INTRODUCTION
In the complex world of healthcare, good
teamwork among the members of the
multidisciplinary team (MDT) that cares
for patients is promoted as essential to
ensure best outcomes, as well as best use
of limited human and capital resources.
1–
3
This suggests that an understanding
exists of the relationship between health-
care outcomes and particular MDT char-
acteristics. It also implies that it is
necessary to understand and develop the
attributes that permit individuals to func-
tion effectively in the MDT.
In reality, ‘practical and well-evaluated
plans for implementing teamwork are
fairly rare’, and evidence of the effective-
ness of teamworking is not measured and
reported systematically by healthcare pro-
viders.
4
The characteristics of effective
MDTs have been described in overall
terms,
1–4
and several instruments have
been described for assessing teamwork
effectiveness
5–8
though no single standar-
dised instrument appears to be in wide-
spread use. By contrast, the attributes
needed by individual team members to
work effectively in the MDT have not
been widely investigated,
2
and aside from
one scale intended to assess nurses’opi-
nions toward other MDT members,
9
studies have not sought to measure indi-
vidual performance in the MDT, nor are
instruments described for measuring such
performance.
Annually in the UK, newly qualified
doctors join MDTs in hospitals to under-
take foundation training for their subse-
quent specialties, becoming responsible
with their MDT colleagues for the deliv-
ery of safe and effective healthcare.
ORIGINAL RESEARCH
McGettigan P, et al.BMJ Qual Saf 2013;0:1–8. doi:10.1136/bmjqs-2012-001418 1
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Working in the MDT is generally a new experience
because medical undergraduate training focuses dom-
inantly on acquiring clinical competence. During the
first 2 years of practice, the Foundation Programme
‘ensures that newly qualified doctors develop their
clinical and professional skills in the workplace’.
10
Though considered essential for good healthcare out-
comes, MDT working skills of new doctors are, never-
theless, not formally assessed. In this study, we aimed
to develop and test an instrument to assess the MDT
performance of newly qualified doctors (Foundation
Year 1 (FY1) doctors). We also wished to explore
whether Hull York Medical School (HYMS) gradu-
ates, whose final year curriculum included 2 weeks of
interprofessional training in a ward setting, were rated
more highly in the MDT than graduates without such
training.
METHOD
Repertory grid technique
Repertory grid technique (‘RGT’) is one of the
methods of Personal Construct Psychology.
11
We used
this method because there seems to be no comprehen-
sive listing of the attributes FY1 doctors require to
work well in teams that has actually been drawn from
those who would most appropriately be able to iden-
tify them, that is, other, more experienced members
of MDTs who work with FY1 doctors. As ‘RGT’is
based on the precept that the researcher would
conduct interviews with a sample taken from the
target group to elicit such attributes,
12
the method
seemed ideal for this study.
RGT has been used in a very wide range of con-
texts, for example, organisational development,
teacher development, psychotherapy, nursing, man-
agement development and so on,
12, 13
to understand
how people ‘construe’(ie. see, understand, interpret)
people, situations and things. Repertory grids are not
standardised tests or questionnaires, so it is up to the
researcher to design a grid to suit the particular
research project.
12
In this study, the purpose of the
repertory grid was to see how members of MDTs con-
strued FY1 doctors in the context of the attributes
needed by such doctors to work well in MDTs.
A repertory grid consists of ‘elements’(the column
headers), ‘personal constructs’(the labels that describe
the rows of the grid) and a method for linking the
two together—usually a rating scale.
14
The compo-
nents of a repertory grid are:
▸Elements. These are the people, situations or things con-
strued. Elements must be carefully selected so that they
are relevant for purpose of the grid.
12
In this study, we
were concerned with how participants (ie, members of
MDTs) construed FY1 doctors, so the elements were
FY1 doctors with whom the participants had worked,
together with an ‘Ideal’element.
▸Constructs. The means by which people construe
are through their ‘personal constructs’. These are
bipolar dimensions, such as kind-vs-cruel and
lazy-vs-hardworking.
12
We were interested in how partici-
pants would construe the elements on a range of con-
structs relating to the attributes required to work well in
MDTs. An example of a construct used is the attribute
poor team player-vs-good team player. The 15 constructs
identified by the MDT members are listed in the grid
page shown in online supplementary appendix 1. The
words ‘construct’and ‘attribute’are used interchangeably
in this article, and references to them are shown in italics
for clarity.
▸Rating scale. The means by which a construct is ‘linked’
to an element is commonly a rating scale, for instance,
of 1–7 as used in this study (see online supplementary
appendix 1).
12
A participant would rate the FY1 doctor
(element) concerned on the construct does not reflect
and learn from experience-vs-reflects and learns from
experience on a scale of 1 (someone who does not reflect
and learn from experience at all) to 7 (someone who
very much does).
Developing the repertory grid
To elicit the constructs (attributes) needed by FY1
doctors to enable them to work well in MDTs, the
authors conducted individual, confidential interviews
with 10 health professionals representative of an
MDT (3 staff nurses; 1 pharmacist; 2 physiothera-
pists; 2 occupational therapists; 2 senior doctors). In
eliciting a representative sample of personal constructs
from a homogeneous population in a particular
setting (eg, hospital healthcare professionals), usually
only small numbers need to be interviewed
15
and,
indeed, we found that the same constructs emerged
repeatedly from different participants.
Interview participants wrote on index cards the
initials of particular FY1 doctors with whom they
worked (the ‘elements’). These were then presented to
them in groups of three, and they were asked to think
of ways in which, in the context of effective MDT
working, two of the elements were alike, but different
from the third. This gave rise to the constructs that
formed the basis for the 15 attributes used in our
study, for example, prioritises tasks efficiently-vs-not
good at prioritising tasks efficiently. This ‘Triadic
Method’of construct elicitation is explained in detail
in Fransella et al.
12
To elaborate the meaning behind the construct
labels, the techniques of ‘laddering’
16
and ‘pyramid-
ing’
17
were also used in the interviews. A person’s
personal constructs do not exist in isolation; they are
arranged in a hierarchical system with some being
more important, value-laden constructs (‘superordin-
ate’), and some being less important, more ‘concrete’
constructs (‘subordinate’). Laddering is used to elicit
superordinate constructs, while pyramiding is used to
elicit subordinate constructs. An example of a rela-
tively superordinate construct is can be trusted to
complete what they have agreed to do-vs-unreliable in
Original research
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delivering their undertakings. It is worth noting that
participants nearly always said that the ‘top’construct
in their respective ‘ladders’related to patient safety.
The prioritising tasks construct mentioned above is an
example of a more subordinate, concrete, construct.
The construct elicitation interviews created a ‘pool’
of approximately 200 cards with individual constructs
written on them. We categorised these into ‘groups of
like meaning or theme’,
15
resulting in 15 bipolar con-
structs carefully selected to represent these groups.
These were the constructs used in the repertory grid
created to gather our study data. The final grid, a
page of which is shown in online supplementary
appendix 1, was presented to participants in a grid
‘booklet’.
The ‘elements’in the grid booklet were the individ-
ual FY1 doctor/s known to each study participant with
a separate page for each ‘element’.
18
The participant
rated the FY1 doctor concerned on each of the 15 con-
structs listed on the grid page on a scale of 1–7. To
prevent participants developing a ‘mental set’, positive
and negative poles were randomly allocated so that for
certain constructs, 1 was the positive pole, and 7 the
negative pole, and vice versa for others. An ‘Ideal’FY1
doctor element was also included as one of the pages
in the booklet. Participants were asked to rate the
‘Ideal’FY1 doctor element on each construct. This was
to provide an ‘anchor’for the grid, making it clear
what MDT members considered to be the ‘ideal’level
of FY1 performance in respect of each construct.
The final page of the booklet contained a table of
the same 15 constructs used in the grid pages, and
participants were asked to rank order these (1–15) to
indicate their relative importance to them personally.
Equal rankings were not permitted.
Data collection
The study participants were MDT members working
on wards at five hospitals in the northeast of England.
Patients were not involved. Approval for the study
was granted by Hull and East Yorkshire NHS
Hospitals Clinical Governance Unit, North
Lincolnshire and Goole Hospitals NHS Foundation
Trust Clinical Audit Unit, North and East Yorkshire
Alliance Research and Development Unit, and Hull
York Medical School Ethics Committee. All partici-
pants provided informed consent. FY1 doctors’ano-
nymity was preserved by assigning to each a numeric
code that was stored securely on a password-protected
database. Their medical school of graduation was
obtained from their hospitals.
Nurse managers were asked for permission to
approach ward MDT staff to explain the study. Staff
expressing interest were consented, given a grid
booklet to complete, and an envelope for return.
Some MDT members completed the grids at once.
Others returned them by an agreed day. All data were
collected between November 2010 and April 2011.
RESULTS
A total of 95 participants rated between 1 and 5 FY1
doctors (elements) with whom they worked. In all,
205 ratings were completed on 57 different FY1
doctors. The participants’professional groups com-
prised 58 nurses, 16 senior doctors (registrar level and
above), 8 physiotherapists, 3 pharmacists, 3 care assis-
tants, 2 dieticians, 2 ward clerks, and 3 who did not
specify profession. These numbers are representative
of hospital staffing proportions, and of the typical
makeup of the multidisciplinary teams, and samples
came from different hospitals (tertiary and district),
and across different teams including acute admitting
units, surgical teams, anaesthetic, general and specialty
medical teams.
Most participants (n=85; 89%) rated the ‘Ideal’
FY1 element. Eighty participants (84%) correctly
completed rankings of the 15 constructs. They com-
prised 45 nurses, 13 senior doctors, 8 physiothera-
pists, 3 occupational therapists, 2 care assistants, 2
pharmacists, 2 dieticians, 2 ward clerks and 3
profession-unspecified participants.
The FY1 doctors were grouped by medical school
of graduation of which 21 were from HYMS and 25
were graduates of 8 other UK medical schools, 9 were
graduates of non-UK schools and 2 were unknown.
Analysis of the repertory grid ratings of FY1 doctors
We examined the ratings to determine whether parti-
cipants from different professional groups construed
FY1 doctors differently in terms of the team work
attributes in the grids. Owing to small numbers in
some of the professional groups of participants, we
limited this analysis to nurses (n=58) and senior
doctors (n=16), and results are shown in table 1.
Because individual FY1 doctors had different numbers
of ratings, the statistical analyses were made using
both the full dataset and the average of all ratings
given for a particular FY1, so that s/he had a single
mean rating for each construct. The patterns of results
were the same when using this average, so all analyses
in this paper are presented using the full dataset. All
analyses were undertaken using SPSS V.18.
In table 1, positive numbers (closest to +3) repre-
sent best levels of performance, and negative numbers
(closest to −3) represent poorer performance. Staff
nurses and doctors did not rate the FY1 doctors sig-
nificantly differently on any construct (p values range
from 0.09 to 0.95), suggesting agreement on the
overall preparedness, or lack of it, of the FY1 doctors
in terms of attributes (constructs) relating to good
multidisciplinary team-working. The other MDT
groups were very similar in their average ratings, but
rated too few FY1 doctors to support statistical com-
parisons between them.
Ratings for different FY1 graduate groups were
examined. Graduates were identified as being from
one of nine UK medical schools, including HYMS, or
Original research
McGettigan P, et al.BMJ Qual Saf 2013;0:1–8. doi:10.1136/bmjqs-2012-001418 3
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as non-UK graduates. Each UK school had from one
to 89 rating grids completed for their graduates with
an average of nine grids. There were 89 grids for
HYMS and 85 for other UK schools (total=174
grids). The non-UK graduate group had 27 grids in
total. For four grids, school of graduation could not
be determined.
An overall analysis of variance (ANOVA) comparing
the average ratings of different graduate groups
(HYMS, other UK medical schools, non-UK gradu-
ates) was highly significant (F=37.61, p<.0001). A
posthoc analysis using Bonferroni adjustments for
multiple comparisons indicated that there were no
statistical differences between HYMS graduates and
those from other UK medical schools. Thus, for sub-
sequent analysis, the UK graduates were amalgamated
in a single ‘UK graduate’group. The UK and non-UK
graduate groups were compared, and the mean ratings
on individual constructs in the grid are shown in
figure 1. They indicate that non-UK graduates had
lower ratings than UK graduates, particularly for attri-
butes relating to decisiveness,evaluating patient risk
and prioritising tasks. Both UK and non-UK FY1
groups were rated lower than the ‘Ideal FY1’on all the
attributes.
Analysis of the ranking of constructs
Eighty MDT members ranked the constructs in order
of importance to them personally (most important=1
to least important=15, with no equal rankings
allowed).
Figure 2 shows the mean ranking of each of the 15
constructs, ordered from most important to least
important.
An overall ANOVA for each construct did not indi-
cate that MDT professional groups ranked the con-
structs significantly differently. Differences in the
mean rankings cannot be considered robust for the
smaller groups of MDT professionals. t-tests compar-
ing the two largest groups, nurses (n=45) and doctors
(n=13), did not show any constructs with mean rank-
ings that were statistically different ( p values from
0.20 to 0.87).
A factor analysis was undertaken to examine the
inter-relationships among construct rankings. A princi-
pal component analysis was run with a varimax
Table 1 Average rating of FY1 doctors on each construct by staff nurses and senior doctors*
Construct Team role Mean rating t- Value p Value (2-tailed)
Learns from experience Staff nurse (n=137 grids) 1.49 −0.07 0.95
Senior doctor (n=31 grids) 1.51
Values expertise of others Staff nurse 1.69 0.15 0.88
Senior doctor 1.64
Deals with events in rational/decisive manner Staff nurse 0.80 −1.06 0.29
Senior doctor 1.16
Anticipates risks/safety issues Staff nurse 1.07 −0.58 0.56
Senior doctor 1.56
Prioritises tasks efficiently Staff nurse 0.93 −1.72 0.09
Senior doctor 1.52
Makes effort to be sociable Staff nurse 1.76 0.55 0.59
Senior doctor 1.58
Clinically capable Staff nurse 1.24 0.95 0.35
Senior doctor 0.94
Can be trusted to complete undertakings Staff nurse 1.49 −0.38 0.70
Senior doctor 1.61
Takes into account all aspects of care Staff nurse 0.57 −0.11 0.91
Senior doctor 0.61
Understands expertise of team Staff nurse 1.39 0.36 0.72
Senior doctor 1.29
Develops rapport with patients Staff nurse 1.52 −0.20 0.84
Senior doctor 1.58
Enthusiastic about work Staff nurse 1.52 −1.32 0.18
Senior doctor 1.94
Communicates clearly and precisely Staff nurse 1.58 0.32 0.75
Senior doctor 1.48
Acknowledges importance of all opinions Staff nurse 1.65 −1.39 0.17
Senior doctor 2.03
Good team player Staff nurse 1.71 −0.45 0.65
Senior doctor 1.84
*Range of ratings is from +3=most positive to −3=most negative; 137 elements were rated by 58 staff nurses, and 31 were rated by 16 senior
doctors.
FY1, Foundation Year 1.
Original research
4McGettigan P, et al.BMJ Qual Saf 2013;0:1–8. doi:10.1136/bmjqs-2012-001418
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Figure 1 Graph of average ratings of individual constructs by place of graduation. * All constructs were significantly different
between all UK graduates (n=46 FY1 doctors with 178 grids) and non-UK graduates (n=9 FY1 doctors with 27 grids) at p<.0001; all
constructs were significantly different between all FY1 doctors and the ideal FY1 doctor (n=85 grids) at p<.0001. Note on table
layout: For presentational purposes only, the graphical layout has been adapted to illustrate the bipolarity of the constructs.
Accordingly, the 1–7-point rating scale was converted into a −3 to +3 seven-point rating scale, with zero representing the ‘4’on the
original 1–7 scale. As space does not permit both labels to be shown on the tables and figures, only the labels for the positive poles
of the constructs are shown, and positive ratings are reflected in the (+) side of the rating scale. This transformation of the data
permits use of horizontal bar charts shown in figure 1 which optimally illustrate whether a mean rating falls on the positive or
negative pole of a given construct.
Figure 2 Graph of mean ranking of constructs.
Original research
McGettigan P, et al.BMJ Qual Saf 2013;0:1–8. doi:10.1136/bmjqs-2012-001418 5
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rotation which resulted in 6 factors with eigenvalues
greater than 1 accounting for 64.7% of the variance.
The factor loadings are shown in table 2.
Examining items that load at least 0.5 on the first
four factors, marked by an asterisk in the table, some
consistencies emerge. The first factor, accounting for
14.5% of the variance, contains five items: deals with
events in a rational/decisive manner, anticipates risks/
safety issues and clinically capable which are nega-
tively correlated with makes effort to be sociable and
enthusiastic about work.
The second factor, accounting for 11.5% of the
variance, again trades-off the ranking of prioritises
tasks efficiently and acknowledges importance of all
opinions, while the third factor similarly trades-off
can be trusted to complete undertakings and takes
into account all aspects of care. The fourth factor
positively relates values expertise of others and under-
stands expertise of team.
Considering the factors extracted, two constructs
making up factors 5 and 6 consist of one item each
which contribute to explaining the variance, but do
not seem to relate consistently to the ranking of other
items. One item, good team player, had moderate
loadings on four of the six factors, indicating that it
was positively related to the more ‘social’constructs,
but was not as closely linked to particular items as
others were.
DISCUSSION
This study demonstrates that RGT can be used suc-
cessfully both to elicit the attributes (constructs)
required by FY1 doctors for good MDT performance,
and to evaluate FY1 doctors on those constructs to
indicate how they are performing, as judged by their
MDT colleagues. Rank ordering the constructs per-
mitted their relative importance to MDT members to
be quantified.
Professional group comparisons
There were no major differences between senior
nurses’and senior doctors’ratings for the FY1
doctors with whom they worked suggesting that these
professionals have similar judgements and expecta-
tions of FY1 doctors’MDT performance. Using the
‘Ideal FY1’to anchor ratings, participants rated FY1
doctors with whom they worked less highly than the
‘Ideal FY1’suggesting that they used the grid mind-
fully, and could judge where an individual FY1 doctor
fell short of the expected ideal and, indeed, where the
absolute ideal, in terms of the highest possible rating,
might not actually be necessary or expected. This sug-
gests a realistic view that FY1 doctors are commencing
training and, therefore, are still learning these skills.
FY1 between groups comparisons
There were no statistical differences between FY1
HYMS graduates and those from other UK medical
schools suggesting that interprofessional training had
not affected performance based on the perceptions of
the MDT team members for the attributes measured.
Graduates from different UK medical schools were all
rated similarly. However, there were significant differ-
ences between UK and non-UK graduates’ratings for
multiple constructs. The number of non-UK graduates
was very small, so this finding would need further
research in different contexts, and using much larger
samples to support it. Other studies have also
reported differences in performance between locally
trained graduates and those who trained in other
Table 2 Factor analysis of construct rankings
Component
123456
Learns from experience −0.08 −0.01 0.08 −0.02 0.02 −0.91*
Values expertise of others 0.07 0.12 −0.12 0.73* −0.27 −0.06
Deals with events in a rational/decisive manner −0.50* −0.39 0.35 −0.23 −0.08 0.22
Anticipates risks/safety issues −0.58* −0.42 0.11 −0.05 −0.01 0.27
Prioritises tasks efficiently 0.10 −0.61* 0.30 −0.30 −0.24 0.00
Makes effort to be sociable 0.67* 0.12 0.04 0.06 0.00 0.14
Clinically capable −0.51* 0.20 −0.26 −0.22 0.30 0.23
Can be trusted to complete undertakings −0.22 −0.14 0.74* −0.10 0.02 0.06
Takes into account all aspects of care −0.29 −0.19 −0.76* −0.02 0.17 0.21
Understand expertise of team 0.08 0.05 0.03 0.81* 0.14 0.08
Develops rapport with patients 0.12 0.05 −0.15 −0.13 0.87* −0.04
Enthusiastic about work 0.77* −0.18 −0.07 −0.04 0.02 0.08
Communicates clearly and precisely 0.16 0.15 −0.38 −0.16 −0.47 −0.38
Acknowledges importance of all opinions −0.02 0.78* 0.10 0.06 −0.07 −0.02
Good team player 0.32 0.45 0.01 −0.26 −0.40 0.17
*Factor loadings of 0.5 or greater.
Original research
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countries.
19, 20
In terms of testing the grid, a primary
aim of this study, a demonstration of its capacity to
distinguish between performances is informative, sug-
gesting that it is potentially of value in distinguishing
areas of strength in FY1 doctors’MDT performance
from those needing remediation.
In identifying areas where FY1 doctors’MDT per-
formance deviated from that anticipated of the ‘Ideal
FY1’and in highlighting differences in performance
between FY1 graduate groups in interactions with the
MDT, the grid is potentially of assistance in prioritis-
ing FY1 training needs, and in focusing educational
and social support where it is most required. This
information could contribute to induction training
programmes, such as that currently under develop-
ment by the UK General Medical Council.
21
Relative importance of constructs—the ranking exercise
While participants expressed great difficulty in ranking
constructs because they felt they were all important,
the mean rankings indicate that being clinically capable
in terms of knowledge, skills and other ‘clinical’con-
structs was considered more important than ‘social’
constructs, such as makes an effort to be sociable and
enthusiastic about work. The factor analysis revealed a
negative correlation between clinical and social con-
structs of performance, suggesting that when forced to
decide, participants prioritised clinical competence
over ‘softer’social skills. Further research is required
to reveal whether the two categories of team-working
constructs (clinical and social) are truly trade-offs that
are in tension with each other and/or whether their
relative importance changes in different situations.
Limitations of the study
The primary aim of this study was to create an instru-
ment to gather preliminary validation data for the use
of RGT in evaluating MDT working. Further studies
could identify whether different constructs (attributes)
are needed by members of MDTs who are not FY1
doctors, to enable them to work well in MDTs, and to
see whether there are ‘team’constructs that all MDT
members need for good team working, as well as to
test the current grid in other settings. Work is also
required to explore the rationale underlying the intri-
guing finding that the team considered all constructs
to be important, but when forced into a ranking,
chose the clinical competencies as more important.
We believe that it is important to explore further what
would be lost if these constructs were missing from a
team (eg. because clinical competence is seen as the
only important attribute in practice). For instance, in
one interview, a senior nurse stated that she strongly
believed that a construct such as understanding the
expertise in the team is critical if team members are to
support each other and utilise the strengths of the
members effectively. Another important issue is what
constructs (attributes) might be missing from the list
identified in this research. For instance, there is
nothing in the list of constructs we identified about
‘having confidence in reporting mistakes-vs-being
afraid to own up to errors I have made’.
Conclusions
RGT has for long been used in connection with the edu-
cation of professionals
22
and team development
23
but
not, as far as we can determine, for MDT development,
though Mazhindu and Pope
24
used RGT to explore the
case for interprofessional education for nurses. Its flexi-
bility is such that it could be used to create a team devel-
opment tool for health professionals working in any
setting. As we have illustrated, RGT may be used to
create a standardised competence-assessment instrument
that could guide the development of MDT skills for a
particular professional group, FY1 doctors.
Alternatively, because the composition of multidisciplin-
ary teams and the cultures of hospitals in which they
work may vary, another application of our research is in
using RGT to create customised instruments that indi-
vidual teams then use themselves to identify, evaluate
and develop the specific attributes (constructs) needed
for good team working in their particular multidisciplin-
ary team.
As stated in a policy synthesis review in Canada,
‘Teams function differently depending on where they
operate ... This wide variety of settings and tasks
means that transferability of processes is not always
straightforward.’
25
Similarly, attributes needed by new
doctors may vary somewhat, or be expressed differ-
ently by teams. By using RGT, or by adapting the grid
in this study to local requirements or language, the
information thereby collected could be used as a
sophisticated method to help build an optimally func-
tioning team, with feedback and training adapted to
their own needs. The instrument would permit indi-
vidual multidisciplinary teams to explore (1) what the
attributes so identified mean to them, (2) what ‘level’
of each attribute each team member possesses and
(3) how the team might cooperatively develop an edu-
cational plan to improve the working of the team and
to identify support and training needs for individual
MDT members.
Acknowledgements Our thanks are due to the staff, past
and present, at Ward 2 in Goole and District
Hospital, where HYMS students undertook
interprofessional training, and where our
consideration of assessment of FY1 doctors’MDT
performance began; to the MDT members who
assisted in construct elicitation; to the clinical audit
teams and MDT participants in the study hospitals;
and to HYMS for partial financial support.
Contributors PM and JM initiated the study. NR
provided expertise throughout on repertory grid
methods and analysis. PM, JM, NR, SH and CD-W
Original research
McGettigan P, et al.BMJ Qual Saf 2013;0:1–8. doi:10.1136/bmjqs-2012-001418 7
group.bmj.com on January 30, 2013 - Published by qualitysafety.bmj.comDownloaded from
conducted interviews and categorised into final
constructs. SH, CD-W and TM collected the majority
of grid data under the supervision of PM. JM
conducted the statistical analysis. PM, JM and NR
wrote the initial draft of the paper and all authors
contributed comments to final version.
Funding A small amount of development funding for
evaluation and research was given by Hull York
Medical School.
Competing interests None.
Ethics approval North and East Yorkshire Alliance
Research and Development Unit, Hull and East
Yorkshire NHS Hospitals Clinical Governance Unit
and North Lincolnshire and Goole Hospitals NHS
Foundation Trust Clinical Audit Departments.
Provenance and peer review Not commissioned;
externally peer reviewed.
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doi: 10.1136/bmjqs-2012-001418
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Patricia McGettigan, Jean McKendree, Nick Reed, et al.
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multidisciplinary teams: a tool for
Foundation Year 1 doctors in
Identifying attributes required by
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