Consultant Interviews - The Advisory Appointment Committee (AAC)

The AAC is the body commonly referred to as "the interview panel". Its ultimate role is to recommend the name of one or several candidates who would be suitable for appointment. The AAC gets involved in the shortlisting process as well as the consultant interview process. No one can be appointed to a consultant post without presenting themselves in front of an AAC, even if this means having to do the interview by video link.

Important note: As the name indicates, the AAC advises the Trust but does not actually makes the final decision. Technically speaking it is the Trust (i.e. the Board, which includes the Chief Executive and the Medical Director) who make the final decision, though in practice the Trust often delegates the decision to the members of the AAC. This is an important to bear in mind because (i) in Trusts where there are a lot of politics we have seen Chief Executives override the AAC's decision and (ii) when you go for an interview, you need to remember that the final decision does not rest in the hands of the clinicians.

Who sits on the AAC?

The Regulations impose that six key individuals MUST sit on the AAC. They are:

Lay member (who is often the Chairman of the Trust or a non-executive Director)
Chief Executive of the Trust or another Board level representative
Medical Director of the Trust
Consultant from the relevant speciality (in most cases, several can sit on the panel, )
Royal college representative
University representative if the post has teaching and/or research commitments.

No recruitment can take place unless all those members are in place. Note that technically the Clinical Director does not have to be part of the AAC though they are often of course invited as part of the consultant body. In addition the Trust is free to include additional members as it wishes. In some cases, relevant consultant from other specialities may also be part of the AAC, as do >colleagues from other professions (e.g. nurses, midwives, managers). Some specialities also invite service users (e.g. psychiatry) or PCT representatives if appropriate. The only criterion which is imposed is that the AAC should have both a local and a medical majority (though these may not always be from the candidates' speciality).

The Royal College should not be employed by the Trust and if possible should be employed by a Trust which is geographically distant from the recruiting Trust. In many cases this rule is respected. However, the notion of "geographical distance" is not defined in the regulations and some Trusts use this ambiguity to use a nearby Royal College Representative, who may become a powerful ally for the clinicians on the panel.

Note: Though most AAC panels contain 8 people, some can contain up to 14 (not unheard of in Scotland or Northern Ireland).

Who matters on the AAC?

All members of the AAC matter though, obviously, the weight that they bear on the final decision is different depending on their role, the nature of the post and relationships within the panel. For example, the primary role of the Royal College Rep is to determine whether the specifics of the post are fair in relation to other posts available and whether a candidate has received the relevant training for the post. He would not be expected to comment on the suitability of candidates to fit within the team in question (since he is not working in that team). Similarly, the Medical Director would not be expected to bear judgement on a candidate's clinical judgement or experience since he is most often from a different speciality. However, he would be expected to test and comment on a candidates' sufficient understanding of governance issues.

The panel is essentially made up of three groups of people:

The Managers (Chief Executive + Medical Director)
The Clinicians (Clinical Director + Consultants)
The external representatives (College + University)

under the watchful eye of the Chairman. These different groups have different expectations of the candidates, which in turn influences the questions that they may be asking.

The Managers will tend to ask interview questions relating to the Trust and your contribution towards it, all aspects of clinical governance, relationships with other specialties, your interpersonal skills, dealing with conflict and difficult colleagues, NHS politics and other high-level questions as well as your management experience.

The Clinicians will tend to ask interview questions on the relevance of your experience, how you plan to develop new skills going forward, service improvement and development, as well as clinical governance. In some cases, they may ask clinical questions too or questions relating to ethical issues pertinent to the post.

The external representatives will tend to ask interview questions relating to your training, various aspects of your consultant CV, as well as your teaching and research experience, their validity and how you plan to develop them going forward.

How does the AAC make the final decision at the interview?

The decision process is very much left to each Trust to organise and depending on the type of post available and the nature of the Trust, the process can vary greatly.

1. Voting scheme

In some Trusts, the process is a voting process where each member of the panel carries one vote. Then it is simply a numbers' game with the candidate getting most votes being given the job. In some cases, some members of the panel can be given a double vote (for example, if the job is mostly a clinical post then the clinicians may have more of a say). Conversely some members may not have a vote (e.g. Chairman, Royal College representative) but are encouraged to voice concerns which may then influence the final outcome. For example, if the Royal College representative found that a particular candidate did not have appropriate training for the post, he would almost have a right of veto (though one would hope that such candidate would not have been shortlisted in the first place).

The advantage of the voting scheme is that it is easy to implement. However it mostly relies on decisions being made on personal feelings (which some argue is not a bad thing). It works best when there are only 1 or 2 good candidates. From a logistical point of view it can be difficult to implement if there are more than 2 candidates sharing 8 votes.

One major disadvantage of this method is that it is not very open since candidates can get rejected simply based on the fact that someone appeared better and it can then be difficult to obtain any meaningful feedback.

2. Marking scheme

Some Trusts adopt a marking scheme whereby each candidate is marked by each member of the panel (with all members marking only those questions which they are qualified to mark. For example, the Chairman would not mark a question relating to a clinical topic). The marks are then added up and the candidate with the best mark gets the job. This system is rapidly spreading throughout the Trusts because it forces everyone to keep track of how candidates were marked on each question and therefore makes it easier to justify why a specific candidate was given the job when another one wasn't.

However our experience shows that, although such marking system gives the impression of a fairer and more scientific process, in reality there can be wide variations between marks, indicating that personal feelings can drive the marking anyway. Also, in many interviews, the marking criteria can be very loose and subject to personal interpretation (e.g. "Has demonstrated a good understanding of governance" which can be difficult to measure and very subjective), meaning that the marking process is not always as fair as it seems. More and more Trusts are now moving towards an OSCE-type recruitment process and these inevitably move away from the voting scheme towards the marking scheme.

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