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The ability to work under pressure is a vital non-technical skill for doctors working in acute medical specialties. Individuals who evaluate potentially stressful situations as challenging rather than threatening may perform better under pressure and be more resilient to stress and burnout. Training programme recruitment processes provide an important opportunity to examine applicants' reactions to acute stress. In the context of multi-station selection centres for recruitment to anaesthesia training programmes, we investigated the factors influencing candidates' pre-station challenge/threat evaluations and the extent to which their evaluations predicted subsequent station performance. Candidates evaluated the perceived stress of upcoming stations using a measure of challenge/threat evaluation--the cognitive appraisal ratio (CAR)--and consented to release their demographic details and station scores. Using regression analyses we determined which candidate and station factors predicted variation in the CAR and whether, after accounting for these factors, the CAR predicted candidate performance in the station. The CAR was affected by the nature of the station and candidate gender, but not age, ethnicity, country of training or clinical experience. Candidates perceived stations involving work related tasks as more threatening. After controlling for candidates' demographic and professional profiles, the CAR significantly predicted station performance: "challenge" evaluations were associated with better performance, though the effect was weak. Our selection centre model can help recruit prospective anaesthetists who are able to rise to the challenge of performing in stressful situations but results do not support the direct use of challenge/threat data for recruitment decisions.

Introduction: Multisource feedback (MSF) ratings provided by patients and colleagues are often poorly correlated with doctors' self-assessments. Doctors' reactions to feedback depend on its agreement with their own perceptions, but factors influencing self-other agreement in doctors' MSF ratings have received little attention. We aimed to identify the characteristics of doctors and their rater groups that affect self-other agreement in MSF ratings. Methods: We invited 2454 doctors to obtain patient and colleague feedback using the UK General Medical Council's MSF questionnaires and to self-assess on core items from both patient (PQ) and colleague (CQ) questionnaires. Correlations and differences between doctor, patient and colleague mean feedback scores were examined. Regression analyses identified the characteristics of doctors and their rater groups that influenced self-other score agreement. Results: 1065 (43%) doctors returned at least one questionnaire, of whom 773 (73%) provided self and patient PQ scores and 1026 (96%) provided self and colleague CQ scores. Most doctors rated themselves less favourably than they were rated by either their patients or their colleagues. This tendency to underrate performance in comparison to external feedback was influenced by the doctor's place of training, clinical specialty, ethnicity and the profile of his/her patient and colleague rater samples but, in contrast to studies undertaken in nonmedical settings, was unaffected by age or gender. Discussion: Self-other agreement in MSF ratings is influenced by characteristics of both raters and ratees. Managers, appraisers, and others responsible for interpreting and reviewing feedback results with the doctor need to be aware of these influences. (Contains 2 tables and 2 figures.)

The article presents a study that investigated the extent of aggregating patients' ratings of doctors' communication skills at practice in leveling mask variation between general practitioners within a practice. The study reveals the implications of doctors' communication skills for interpreting organizational level scores, the proportion of variance in scores due to difference between practices, and the variability in communication scores between general practitioners within a practice.

Objectives: To determine the extent to which practice level scores mask variation in individual performance between doctors within a practice., Design: Analysis of postal survey of patients' experience of face-to-face consultations with individual general practitioners in a stratified quota sample of primary care practices., Setting: Twenty five English general practices, selected to include a range of practice scores on doctor-patient communication items in the English national GP Patient Survey., Participants: 7721 of 15,172 patients (response rate 50.9%) who consulted with 105 general practitioners in 25 practices between October 2011 and June 2013., Main Outcome Measure: Score on doctor-patient communication items from post-consultation surveys of patients for each participating general practitioner. The amount of variance in each of six outcomes that was attributable to the practices, to the doctors, and to the patients and other residual sources of variation was calculated using hierarchical linear models., Results: After control for differences in patients' age, sex, ethnicity, and health status, the proportion of variance in communication scores that was due to differences between doctors (6.4%) was considerably more than that due to practices (1.8%). The findings also suggest that higher performing practices usually contain only higher performing doctors. However, lower performing practices may contain doctors with a wide range of communication scores., Conclusions: Aggregating patients' ratings of doctors' communication skills at practice level can mask considerable variation in the performance of individual doctors, particularly in lower performing practices. Practice level surveys may be better used to "screen" for concerns about performance that require an individual level survey. Higher scoring practices are unlikely to include lower scoring doctors. However, lower scoring practices require further investigation at the level of the individual doctor to distinguish higher and lower scoring general practitioners., (© Roberts et al 2014.)