Fieldset
Refugees in Jordan: Recruiting the right team
Doctors with Médecins Sans Frontières / Doctors Without Borders have to rise to all sorts of challenges. With several of the team taking time away from the clinic, Mike and his colleagues have to act fast to ensure they can meet the needs of the patients...
 
 
Before joining MSF I’d had experience of recruitment in several ways. In the practices I’d been involved with we recruited staff and I’d often been part of the interview panel, though the process was normally led by the practice manager.
 
I’d also recruited or selected which applicants should get appointed to training schemes for General Practice, first through traditional interviews and then through being quite heavily involved in what evolved to be a national recruitment process. However I’d not expected recruitment to be a big part of my work in MSF…
 
In the project the management team is small. For much of the time I’ve been here, for one reason or another, there have only been two or three of us in the medical team, so I’ve been involved in the recruitment of several nurses, health promoters, pharmacist cover, a data operator and, more recently, a maternity cover doctor.
 
 
The busy waiting area in the clinic

The busy clinic needs qualified staff to ensure patients can manage conditions such as stroke and diabetes. Photo: N'gadi Ikram

 

The appointment of some of the new recruits has reflected the reality that people get pregnant and so need a break from work, and a couple were because the project has been expanding to improve our services. Despite the number of people who have arrived the turnover of staff here is pretty low, so not many of these recruitments were due to staff leaving.
 
Recruitment here is a different experience than in the UK, where I'm from, so I wanted to reflect on this and share my experience of recruiting a doctor recently.
 

How it starts

It was up to me as the medical team leader to identify that we would need to recruit. We have managed to employ one person to cover the absence of two doctors going off on marriage and honeymoon leave, and then the leave of a different colleague who is going on maternity leave. (I wasn’t allowed to ask for wedding, honeymoon and maternity leave cover in the advert, as this might suggest it was all one person!)
 
So, I got permission from the programme coordinator and then, through the HR lead in the practice, from the HR (Human Resources) coordinator in Amman for a job advert.
 
MSF jobs are all advertised on one well-known local recruiting site. After a couple of weeks I went to my HR colleague and asked how many applicants we had for the job.
 
The total so far was 126! I remember checking if these were all doctors…
 
At this point I discovered that local policy suggested we could now close the advert, so I verbally agreed to this. 126 seemed masses of candidates for a four-month post.
 

The long list

The next day the nursing manager and I started to go through the applicants (now 131: closing the process had to be done by email, and a few more people had applied before the advert had been taken down!).
 
Going through these 131 applications was a one-by-one process, as I’ve been told there is no effective filter on the site!
 
We ruled out those who were not actually (medical) doctors. I saw some faces that I’d seen on previous reviews of nursing applications, including the odd accountant or medical manager. We got down to 36 people. It was time to define the selection criteria.
 
The initial work had shown that though we had advertised for a family medical specialist, there were not going to be lots of these… But still, time to reflect on how well qualified the Jordanian population is that we got so many applicants for a short-term job.
 
Some criteria are easy: we needed a relatively experienced person, so some measure of time working as a doctor was clearly appropriate. We decided we wanted someone with a minimum of two years' experience.
 
Experience in non-communicable disease (NCD) was clearly a big advantage for us as an NCD programme.
 
 
Selection criteria table

Our selection criteria.

 
It has been locally normal to have both MSF and NGO experience separately as criteria. I’ve had worries that as those who have worked for MSF have by definition worked for an NGO, there is an over-representation of former MSF workers interviewed. We agreed that NGO experience and primary care experience would be our other two criteria, but that anybody who had qualifications as a family medical specialist would get triple points. 
 
Both the family medical specialists we initially shortlisted were unavailable. One because she is actually living in Syria and could not get back in time, and the other has a ministry job and decides this, with its pension rights etc., isn’t something to give up for a four-month NGO role.

 

Exam time

But the remaining 14 people are too many to interview … So, as is common, we invite them all in for a written exam. Though I’ve been part of the examiner community in UK general practice, I’ve not been writing multiple choice question (MCQ) exams. Asking my colleagues who do to breach the security of their database and share some questions was alluring but not ethical. There were some exam questions that had been used in the project before, but people commonly apply knowing this, so we needed new exam questions specifically relevant to non-communicable diseases.
 
 
 
Sample multiple choice questions
Sample multiple choice questions designed to test our candidates' knowledge. Photo: MSF.
 
So another skill to develop! Writing MCQs which are clear and specific is not a quick task. Though there are non-communicable disease guidelines in MSF to adapt into questions, I also used other resources to develop many new questions. Then I had to try to balance the exam with bits from each chronic disease.
 
The exam seemed to work and we got down from 14 potential candidates, to five. who came to interview.
 

Meeting candidates face-to-face

I’d worked out the challenge of doing MCQs well in advance and spread this work out over several days. I was less well set up for interview questions.
 
I was very keen to make sure that we recruited somebody who could make decisions and cope with the realities of a limited set of drugs available and limited investigations.
 
I checked the proposed questions with the (new) medical team leader, who wondered about length but didn’t suggest changes, and clarified one question with my HR colleague. On reflection, I should have listened more to the unsaid concerns and removed a question or two...
 
I’d assumed that my role was a technical one and that having shared the questions to be used I’d finished my responsibilities. So while in the logistics office working on other issues, I was shocked to be told by my HR colleague, minutes before the interviews, that it was my job to print off all the interview questions papers. I decided it wasn’t helpful to argue. I did the printing, we started late… but ran later with my complex, challenging questions…
 

A fair process

Only after the process did I formally hear that the wife of a colleague had been interviewed. (One of the reasons for international staff being involved in all interviews in MSF became evident!) Luckily the relevant colleague had told me, though without her name. I reflected back on whether the process could have been breached at any point. I’m happy it has been fair.
 
After the interview we can’t do anything until the appointment is confirmed by our HR Coordinator, even though we’d followed the defined process. But he is on leave, unexpectedly, so there is a delay… and the doctor's absence gets closer… We cobble together some cover…
 

Post script

Yesterday I sat in with the person we recruited. He is clear-thinking and though none of the patients have met him, the consultations are warm and effective. He knows lots of internal medicine and our team are teaching him lots about primary care.. (I notice too that he scored highest in both the test and the exam… so those hours designing questions may have been well spent!)