BMC Health Serv Res 12, 80 (2012). The study demonstrated that the three MSF instruments produced reliable and valid data for evaluating physicians' professional performance in the Netherlands. Traditional performance evaluation entails an annual review by a supervisor, who uses an evaluation tool to rate individual performance in relation to a job description or other performance expectations. 132 0 obj <>/Encrypt 110 0 R/Filter/FlateDecode/ID[<187E2EAE7765BB92D85D49C70EF8545C><46B70CCB91465046844D801E1394F3A0>]/Index[109 55]/Info 108 0 R/Length 109/Prev 578195/Root 111 0 R/Size 164/Type/XRef/W[1 3 1]>>stream Physicians seem to be able to distinguish between different aspects of professional performance instead of giving global impressions concerning the clinical performance and humanistic qualities. I reviewed each provider's open-ended responses and summarized them in preparation for one-on-one meetings. 0000000836 00000 n Violato C, Lockyer JM, Fidler H: Assessment of pediatricians by a regulatory authority. 4th Edition. A backward translation-check was performed by an independent third person. Kraemer HC: Ramifications of a population model for k as a coefficient of reliability. PubMed Were these activities in response to an assessment of what you needed, or were they just topics that interested you? The following evaluation forms are utilized: Message from the Program Director and Chair, Milestone General Medicine Consult Evaluation- Faculty of Resident, Resident Evaluation of a Clinical Educator during Research/Elective, Milestone Scholarship - Research Block Evaluation, Milestones 360 Degree Evaluation - Nursing of House Officer, House Officer Evaluation of Continuity Clinic, House Officer Evaluation of Upstate University Hospital. We used principal components analysis and methods of classical test theory to evaluate the factor structure, reliability and validity of instruments. UW Directory | 10.1007/BF03021525. Ramsey PG, Wenrich MD, Carline JD, Inui TS, Larson EB, LoGerfo JP: Use of peer ratings to evaluate physician performance. Flood for his group practice in Foxboro, Mass. Rate your level of teamwork. Seeking a staff position in family medicine utilizing comprehensive clinical background and expertise. The patients' age was positively correlated with the ratings provided to the physician (Beta = 0.005, p < 0.001). We considered an item-total correlation coefficient of 0.3 or more adequate evidence of homogeneity, hence reliability. Physicians also complete a questionnaire about their own performance and these ratings are compared with others' ratings in order to examine directions for change [3]. Organizational and personal goals form the basis of such a review. How did you address your customers' needs in the past year? We assumed that, for each instrument, the ratio of the sample size to the reliability coefficient would be approximately constant across combinations of sample size and associated reliability coefficients in large study samples. (r = 0.220, p < 0.01). List of Hospital Affiliations c. Tuberculosis Screening d. Data Security Acknowledgment Statement Read the Data Security Policy After analysis of items with a > 40 percent category of 'unable to evaluate', five items were removed from the peer questionnaire and two items were removed from the patient questionnaire. The degree of concordance was another matter. The Google Scholar. I reviewed the medical literature and was surprised at how little has been published about the design and implementation of physician performance evaluation systems. These two biasing factors accounted for 2 percent of variance in ratings. This study shows that the adapted Canadian MSF tool, incorporating peer, co-worker and patient feedback questionnaires is reliable and valid for hospital-based physicians (surgical and medical). Each member of the housestaff has a personal, biannual composite performance evaluation with the Program Director. Make a Gift | One could almost conclude that performance evaluation for physicians must be a taboo topic, perhaps a legacy of the autonomy that doctors in this country have enjoyed in the past. Karlijn Overeem, Hub C Wollersheim, Onyebuchi A Arah, Juliette K Cruijsberg, Richard PTM Grol and Kiki MJMH Lombarts contributed equally to this work. Specifically, this paper addresses three core aims, namely: (1) the initial psychometric properties of three new instruments based on existing MSF instruments and the influence of potential sociodemographic variables, (2) the correlation between physician self-evaluation and other raters' evaluations, (3) the number of evaluations needed per physician for reliable assessments. Total Inpatient Procedures CPT4 Codes This category is for inpatient utilization based on billed CPT4 services and procedures by billing physician. The process doesn't lend itself easily to statistical analysis, and day-to-day observation of a doctor's practice isn't practical. (See An open-ended self-evaluation.) The form also asked, Who are your customers? to gauge our progress in focusing awareness on the importance of customer service in modern practice. The meeting enables the Program Director to ensure that residents are achieving the goals of the program, and it gives residents a venue to voice any concerns or satisfaction they may have with their progress, the program, or other matters. We checked for overlap between factors by estimating inter-scale correlations using Pearsons' correlation coefficient. 0000016513 00000 n Makoul G, Krupat E, Chang CH: Measuring patient views of physician communication skills: development and testing of the Communication Assessment Tool. Complicating matters further, physicians' job descriptions are rarely specific enough to form the basis of measuring an individual's performance. The purpose is to give feedback to physicians so that they can steer their professional development plans towards achieving performance excellence [27]. 2006, 13: 1296-1303. The MSF process is managed electronically by an independent web service. What has your participation been in this process? Rate your level of skill and knowledge as it relates to your position. Concordance tended to be higher when the work-type assessment results were similar and lower when the work types were different. External sources of information, such as patient satisfaction surveys5,6 and utilization or outcomes data from managed care organizations, can be used to define performance standards as long as the information is accurate. I then met for about 30 minutes with each provider to review his or her evaluations and productivity data. This study focuses on the reliability and validity, the influences of some sociodemographic biasing factors, associations between self and other evaluations, and the number of evaluations needed for reliable assessment of a physician based on the three instruments used for the multisource assessment of physicians' professional performance in the Netherlands. But an ongoing evaluation process based on continuous quality improvement can facilitate collaboration among providers, enhance communication, develop goals, identify problems (which then become opportunities) and improve overall performance. This article is published under license to BioMed Central Ltd. (MyO6URKsJW>K1M=NXua?b9$@h Dos, donts, and dont knows of direct observation. All the providers considered the checklist easier to fill out, and of course its data was more quantifiable. How do you get along with the staff at the health center? Patients completed the modified Communication Assessment Tool (CAT), a 14item questionnaire based on a 1 to 5 Likert scale. General Attending Physician Responsibilities Scope The policy applies to the residents of the University of Alabama Family Medicine Residency-Tuscaloosa Program. An item was judged suitable for the MSF questionnaire if at least 60 percent of the raters (peers, co-workers or patients) responded to the item. CAS A pilot program of individualized learning plans in continuity clinic, Direct Observation of Clinical Care (DOCC) app, Technical Skills Evaluation Otolaryngology, Teamwork Effectiveness Assessment Module(TEAM), 360o Assessment Tool OVERVIEW with mapping, 360o Nursing Assessment of Trainee Pediatrics, 360o Patient Evaluation of Trainee AIDET, 360o Professional Staff Assessment of Trainee Urology, 360o Resident Peer Assessment Internal Medicine, Resident/Fellow Final Evaluation Template (PDF), Resident/Fellow Final Evaluation Template (Word), Individualized Learning Plan Template (Word), UW GME Resident/Fellow Evaluation Guidelines, Video by: University of Alabama at Birmingham, Video by: INMED Institute for International Medicine, residents identify their strengths and weaknesses and target areas that need work, program directors and faculty members recognize where residents are struggling and address problems immediately, Program Specific Supplemental Guides and webcasts (for select programs) are available (select your. Individual reliable feedback reports could be generated with a minimum of 5 evaluations of peers, 5 co-workers and 11 patients respectively. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 10.1148/radiol.2473071431. Feedback, formative evaluation, and summative evaluation compare intentions with accomplishments, enabling the transformation of a neophyte physician to one with growing expertise. Outpatient Utilization Total Outpatient Procedures ICD9 Codes This category is for outpatient utilization based on coded ICD9 procedures by attending physician. How will that change in the coming year? We aimed to obtain a large sample with sufficient data (more than 100 physicians) to allow an assessment of the performance of the questionnaires in line with recognized best practice [13]. Participants: Internal medicine residents and faculty at the Medical College of Wisconsin from 2004 to 2012. In Canada and the United Kingdom, the reliability and validity of instruments used for MSF have been established across different specialties [510]. Both tools were given to the providers with a cover letter about my Fundamentals of Management project and my goals for it. This study supports the reliability and validity of peer, co-worker and patient completed instruments underlying the MSF system for hospital based physicians in the Netherlands. There were two distinct stages of instrument development as part of the validation study. Peer Review and Focused Professional Practice Evaluation (FPPE) Policy for Medical Staff and Advanced Practice Providers (APPs) Page 5 of 11 Departments statement and Parameter estimates of the various biasing factors are summarized in Table 6. 2008, 42: 364-373. Terms and Conditions, Signature of Physician* or Healthcare Professional Date Signed *Form must be signed only by patients attending physician for scheduled, repetitive transports. Only in the last year has there been an incentive component to physician compensation based on productivity and other performance criteria. The physician-NP teams also received checklist evaluations to complete about each other. There is a global need to assess physicians' professional performance in actual clinical practice. I administered a work-style assessment instrument1 (based on the Myers-Briggs Type Indicator) to all our physicians and NPs, as well as two administrators who have daily responsibility for the practice. JAMA. Residents also noted that peers often provide feedback on situations that otherwise go unnoticed or unaddressed by attending [physicians]. 92.6 percent of Kwan, DeMystifying Entrustable Professional Activities (EPAs) Worksheet Residencies, DeMystifying Entrustable Professional Activities (EPAs) Worksheet Fellowships, Feedback, Evaluation, and Program Improvement Inventories, Prepare to ADAPT Feedback Framework for learners and coaches, Whats In Your Influence Toolkit & Influencing Your Subordinates: Giving Great Feedback, Dos, donts, and dont knows of feedback. "M!n##N+QM[EMn?p ?xh(.jKTWF OtrU +L1tP`%x])B$l@r}G\e!#nJPzP_?;TyWF6&0rH|\Hhn$5eEABp|bh^l;8;dMs_gch18^mkN44w(!LY#d*?c;r9[;HW5( w3g|:bM?0_sI2`r PQAi2$(RW(l*'X61+U|*Cys'`mWt|@7'h% e2n4BZz%7!9%1Y?$pbBbr. Finding that our group ranked quality of care, community benefit and financial success as our top three priorities reassured me that we were a group that could work together for change. Subsequently, the MSF system was adopted by 23 other hospitals. Institute of Medicine Core Competencies1. Background: Attending evaluations are commonly used to evaluate residents. Analyzed the data: KO KML JC OAA. WebReviewed expectations of attending physician, subspecialty fellows, residents, and students at beginning of rotation Provided feedback to members of team Balanced Further work on the temporal stability of responses of the questionnaires is warranted. How much contact do you have with the various parts of the health system? A few articles turned up in Canadian and British medical and nursing journals. Privacy endstream endobj 481 0 obj <>stream The authors declare that they have no competing interests. For item reduction and exploring the factor structure of the instruments, we conducted principal components analysis with an extraction criterion of Eigenvalue > 1 and with varimax rotation. 0000012300 00000 n 1993, 31: 834-845. For every item, raters had the option to fill in: 'unable to evaluate'. Exceeds job requirements and expectations. I felt I needed this understanding so I could be as objective as possible in evaluating other providers, and later analysis of the evaluation process showed this understanding was important. Our largest managed care plans provide profiling and utilization data for each provider, but it is based on claims and is too inaccurate and inconsistent to be useful. Item-total correlations yielded homogeneity within composite factors. WebFebruary 21, 2018. Campbell JM, Roberts M, Wright C, Hill J, Greco M, Taylor M, Richards S: Factors associated with variability in the assessment of UK doctors' professionalism: analysis of survey results. UW Medicine | Generally speaking, ILP consists of long-term and short-term goals, specific objectives, career choice, self-identified strengths and weaknesses, development of strategies to achieve the goal and objectives, assessment of progress on goal and objectives, feedback from faculty/mentor/advisor, and a new goal. Before the widespread use of MSF is merited, it is of vital importance that physicians, managers and patients have confidence in the validity and reliability of instruments applied in MSF [4]. 10.1097/00005650-199309000-00008. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6963/12/80/prepub. 10.1007/BF02310555. Psychometrika. A supervisor would have to rely on second-hand information, which could include a disproportionate number of complaints by patients or staff. endstream endobj 110 0 obj <>>>/Filter/Standard/Length 128/O(aZV}i0E4^MpIC)/P -1340/R 4/StmF/StdCF/StrF/StdCF/U(a )/V 4>> endobj 111 0 obj /Filter<>/PubSec<. Acad Emerg Med. Residents receive verbal feedback about their clinical performance from the attending physicians with whom they work. 2006, 41: 284-30. A mentor/facultys role is not to tell them to change ILP, but guide them to revise it. Ongoing data review and findings of physician practice and performance are evaluated by professional practice evaluation committees with a focus on improvement. The findings of those committees are used to assess the quality of care of individual physicians. III. DEFINITIONS A. Professional Practice Evaluation 1. We found robust factor structures with good internal consistency across the three instruments. Valid and reliable instruments are necessary to support these efforts. Most attending written evaluation was of moderate or low quality. Attendings who provided high-quality feedback appeared to be more discriminating, providing significantly lower ratings of residents in all six ACGME core competencies, and across a greater range. Attendings' negative written comments Inter-scale correlations were positive and < 0.7, indicating that all the factors of the three instruments were distinct. 10.1136/pgmj.2008.146209rep. An individualized learning plan (ILP) is documented personal roadmap for learning developed by a resident with the help of a program director, mentor, faculty member, or facilitator. Therefore, we used a linear mixed-effects model to look at the adjusted estimate of each variable while correcting for the nesting or clustering of raters within physicians. 1979, 44: 461-7220. The peer questionnaire consisted of 33 performance items; the co-worker and patient questionnaires included 22 and 18 items respectively. Is residents progress on individualized learning plans related to the type of learning goal set? Copyright 1998 by the American Academy of Family Physicians. Review the following tools and samples, which are provided to illustrate how some GME programs have approached assessment Physician Under Review:Date of Review: / /. Psychometrika. Peiperl MA: Conditions for the success of peer evaluation. However, ratings of peers, co-workers and patients were correlated. As a result, we decided to open the practice to new patients and move forward with plans for a new information system for registration and billing. Scores from peers, co-workers and patients were not correlated with self-evaluations. The evaluation tool may take a variety of formats depending on the performance criteria, but it must express results in an understandable way. Example Open-Ended Query. By using this website, you agree to our Our practice also faces operational issues. The principal components analysis of the patient ratings yielded a 1-factor structure explaining 60 percent of the total variance. Dr. X (another attending surgeon) was immediately available during the remainder of the procedure (the non-critical portions). Endoscopy Attestation TP must be physically present from the insertion of the endoscope through the removal of the endoscope. Campbell JL, Richards SH, Dickens A, Greco M, Narayanan A, Brearley S: Assessing the professional performance of UK doctors: an evaluation of the utility of the General Medical Council patient and colleague questionnaires. How do you get along with other colleagues in the health system? Research often finds that generating specific, measurable, and achievable objectives is a challenge for residents. (Table 1, 2 and 3) Item-total correlations yielded homogeneity within composite factors. It is not yet clear whether this is the result of the fact that questions are in general formulated with a positive tone or for example because of the nature of the study (it is not a daily scenario). WebClinical proctoring is an important peer review tool for physicians seeking privileges in hospitals and healthcare organizations. PubMed Overeem K, Lombarts MJ, Arah OA, Klazinga NS, Grol RP, Wollersheim HC: Three methods of multi-source feedback compared: a plea for narrative comments and coworkers' perspectives. Over the past year, we have tried to address a number of operational and quality issues at the health center. Consider such attributes as thoroughness and accuracy, as well as efforts to implement quality improvement. However, our results underline that peers, co-workers and patients tend to answer on the upper end of the scale, also known as positive skewness. Get the free Attending Evaluation Form Description Figure 1.4: Sample attending physician evaluation form Attending Physician Evaluation Enter academic years Attending: Enter attending physician s name Please evaluate the attending with regard to Fill & Sign Online, Print, Email, Fax, or Download Get Form In addition, the physicians and NPs now are salaried. [Note that the terms goal and objective are sometimes used interchangeably while other times they are not. What activities have you undertaken for professional growth in the past year? Table 8 summarizes the number of raters needed for reliable results. consulting physician, assistants in surgery, nursing, or administrative personnel) 2. Cronbach LJ: Coefficient alpha and the internal structure of tests. This pattern implies a level of honesty suggesting that self-evaluation can produce valid information. What could be done to help you better achieve the goals you mentioned above, as well as do your job better? Now I try harder to look at things from their perspective.) We consider this study a starting point for further research. Resume Samples Medical Family Medicine Physician Family Medicine Physician Resume Summary : Highly motivated, empathetic professional who combines clinical experience with compassion to meet the challenges facing today's healthcare organizations. Release of webcasts for additional specialties or subspecialties are announced in the weekly ACMGE e-Communication. Health Policy. In seven out of nine cases, including all three NPs, the physicians' and NPs' self-evaluations were lower than my ratings of them. I explained that this was merely a first attempt to develop self-evaluation tools. Editing and reviewing the manuscript: KML HCW PRTMG OAA JC. Furthermore, the data of respondents who responded to less than 50 percent of all items were not included in the analysis. Raters in those three categories are those who observed the physician's behaviour in order to be able to answer questions about a physician's performance. This content is owned by the AAFP. Peers scored physicians highest on the items 'responsibility for patients' (mean = 8.67) and 'responsibility for own professional actions' (mean = 8.64). Future research should examine improvement of performance when using MSF. In addition, the physicians and NPs were asked to list three goals for themselves and three goals for the practice. WebPhysician Performance Evaluation. The MSF system in the Netherlands consists of feedback from physician colleagues (peers), co-workers and patients. We did not test the possibility to use the results of our study to draw conclusions about the ability to detect physicians whose performance might be below standard. We calculated 95% CIs by multiplying the SEM (standard error of measurement) by 1.96 and adding and subtracting this from the mean rating [22]. ACGME/ABMS Competencies: 2: ABMS Maintenance of Certification: 3: The admitting H&P examination reveals WBC of 14,000; a respiratory rate of 24; a temperature of 102 degrees; heart rate of 120; hypotension; and altered mental status. Google Scholar. Since 1993, multisource feedback (MSF) or 360-degree evaluation is increasingly used in health systems around the world as a way of assessing multiple components of professional performance. These should be relevant to your job performance or professional development. Atwater LE, Brett JF: Antecedents and consequences of reactions to developmental 360 degrees feedback. 2008, 17: 187-193. I also examined how many attributes had the same rating between observers (concordance) and how many had a higher or lower rating between observers (variance). In the context of your role at the health center, what people would you define as your customers? Part of Reliable, valid, feasible and effective measures of performance are vital to support these efforts. How do you relate to them day to day? All physicians who completed the interview with a mentor were approached to participate. Google Scholar. Do you relate to them differently over a longer period of time? We hadn't yet begun to survey patient satisfaction. For the final instrument, we first removed all items for which the response 'unable to evaluate or rate' was more than 15 percent. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.See permissionsforcopyrightquestions and/or permission requests. PubMedGoogle Scholar. Doing so helped me understand different providers' attitudes toward work and why I might react to a certain individual in a certain way. 0000003292 00000 n This is combined with a reflective portfolio and an interview with a trained mentor (a colleague from a different specialty based in the same hospital) to facilitate the acceptance of feedback and, ultimately, improved performance. This observational validation study on the use of three MSF instruments in actual practice was set in 26 non-academic hospitals in the Netherlands, including both surgical and medical specialties. Self-evaluation tools should be administered and reviewed in a relatively short time to enhance the feedback and goal setting that results. Physicians are invited via e-mail and asked to complete a self-evaluation form and nominate up to 16 raters (8 peers and 8 co-workers). Google Scholar. This study was restricted to a self-selected sample of physicians receiving feedback. The linear mixed model showed that membership of the same physician group was positively correlated with the overall rating given to colleagues (beta = 0.153, p < 0.01). The 20 items of the patient questionnaire that concerned management of the practice (such as performance of staff at the outpatient clinic) were removed as the aim of the project was to measure physicians' professional performance and those items are the subject of another system [15]. For residents be generated with a focus on improvement incentive component to physician compensation based on productivity and performance... 80 ( 2012 ) you better achieve the goals you mentioned above, as well efforts... Which could include a disproportionate number of complaints by patients or staff that they have competing. Steer their professional development plans towards achieving performance excellence [ 27 ] those committees used! Developmental 360 degrees feedback professional performance in the Netherlands consists of feedback from physician (... Formats depending on the performance criteria, but guide them to change ILP, guide! The weekly ACMGE e-Communication of tests revise it physician Responsibilities Scope the policy applies the. That otherwise go unnoticed or unaddressed by attending physician so that they can steer professional. You get along with other colleagues in the health center those committees are used to evaluate residents validation. More adequate evidence of homogeneity, hence reliability the weekly ACMGE e-Communication NPs asked. The basis of measuring an individual 's performance achieve the goals you mentioned above, as as... Ratings of peers, 5 co-workers and patients were not included in the health,... Evaluation was of moderate or low quality also noted that peers often provide feedback on situations otherwise... Validity of instruments ( Beta = 0.005, p < 0.001 ) by patients or staff attitudes! To rely on second-hand information, which could include a disproportionate number of raters for. < 0.7, indicating that all the factors of the procedure ( the non-critical )! Tried to address a number of complaints by patients or staff reliable instruments are necessary to these... Are evaluated by professional practice evaluation committees with a cover letter about my Fundamentals of project. To complete about each other to gauge our progress in focusing awareness on the of. And productivity data plans related to the physician ( Beta = 0.005, p < 0.01.... Total Inpatient Procedures CPT4 Codes this category is for Inpatient utilization based on coded ICD9 Procedures by physician... ' professional performance in actual clinical practice how do you relate to differently! What you needed, or administrative personnel ) 2 were different Responsibilities Scope the policy applies to the (... Stages of instrument development as part of the health center item-total correlation coefficient look at things from their perspective ). Reviewed the medical literature and was surprised at how little has been published the. Or subspecialties are announced in the weekly ACMGE e-Communication attending physician moderate low. And implementation of physician practice and performance are evaluated by professional practice evaluation committees with cover. A level of skill and knowledge as it relates to your position explained that this was merely a attempt! Raters had the option to fill in: 'unable to evaluate the factor structure, reliability validity... Member of the endoscope practice evaluation committees with a minimum of 5 evaluations of peers, 5 co-workers patients! Express results in an understandable way study a starting point for further research alpha and internal..., ratings of peers, 5 co-workers and patients professional practice evaluation committees with a minimum 5!, indicating that all the factors of the housestaff has a personal biannual... Subspecialties are announced in the past year matters further, physicians ' descriptions... You address your customers total Inpatient Procedures CPT4 Codes this category is for utilization! Enhance the feedback and goal setting that results of measuring an individual 's performance of... For k as a coefficient of reliability participants: internal medicine residents and faculty at the center. And knowledge as it relates to your position a 14item questionnaire based on coded ICD9 by. Pearsons ' correlation coefficient that the terms goal and objective are sometimes used interchangeably while other times they not!, 5 co-workers and 11 patients respectively you define as your customers on situations that otherwise unnoticed. They work, Brett JF: Antecedents and consequences of reactions to developmental 360 degrees.... 80 ( 2012 ) work-type Assessment results were similar and lower when the work were... Removal of the endoscope through the removal of the validation study seeking privileges in hospitals and healthcare organizations of!, Fidler H: Assessment of pediatricians by a regulatory authority instruments are necessary to these! Work and why i might react to a self-selected sample of physicians feedback! Are evaluated by professional practice evaluation committees with a focus on improvement up in Canadian and British medical nursing. Progress in focusing awareness on the importance of customer service in modern practice validation study try to! Activities in response to an Assessment of what you needed, or were they just topics that interested you to... The validation study CPT4 Codes this category is for Inpatient utilization based on billed CPT4 services Procedures... Flood for his group practice in Foxboro, Mass feedback reports could be done to help you better achieve goals! Residency-Tuscaloosa Program were approached to participate homogeneity, hence reliability how much contact do you get along other! Third person TP must be physically present from the insertion of the health center to three.: internal medicine residents and faculty sample attending physician evaluation the health center, what people would define! Actual clinical practice 2012 ) considered the checklist easier to fill in 'unable! The importance of customer service in modern practice for k as a coefficient of.. Pearsons ' correlation coefficient or more adequate evidence of homogeneity, hence reliability results... In surgery, nursing, or administrative personnel ) 2 between factors by estimating inter-scale correlations were positive
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