Multi-source feedback (MSF) has become the accepted mechanism of ensuring the appropriate professional behaviour of doctors. It is part of the mandatory assessment of doctors in training and is to be utilized as part of the revalidation of trained doctors. There is significant variation in the models of MSF currently used within the National Health Service and new models of MSF are being designed by various specialties. No single model has been recognized as the 'gold standard'. However, there is a large published literature concerning MSF, both in the context of health systems and, more extensively, within industry. This published literature is reviewed, drawing attention to aspects of MSF systems in which there is consensus on effective approaches as well as other aspects in which there is doubt about the optimum approach. In the light of the review 10 principles key in the development of effective MSF models have been produced.

Guidance on the selection of assessors in any MSF process should take into account findings that rating behaviour varies by staff group.

Assessment of the professional behaviour of doctors is increasingly recognized as an essential component of doctors' training (Ben-David et al., 2004) with equally important implications for doctors in permanent posts. TAB is a proforma for such assessment using a 360 degree process in which up to 15 colleagues of a doctor assess that doctor's professional behaviour. The pro forma is presented, together with discussion of the format and approach developed, with particular reference to the General Medical Council document "Good Medical Practice". We report on initial piloting of the approach in two UK NHS hospital trusts. In total 440 assessments of 30 doctors were completed. Data regarding intra-observer and inter-observer variation indicate that the process is reliable, practical and consistent. We believe this approach may represent a workable way ahead to promoting appropriate professional behaviour on the part of medical trainees and that it offers potential for re-validation of hospital consultants. There is a clear need for further development and evaluation of this approach, most notably its acceptability and value to all involved.

Assessors and trainees found the process practical, valuable and fair. Educational supervisors found it valuable, although only 23% learned something new about their trainees. Clinical tutors valued the system. Administrative staff found it time consuming. The TAB four-domain rating form with its single pass category identified specific concern about volunteer trainees' professional behaviour. Not all trainees received skilled feedback.

The assessment of a trainee doctor's human skills, including teamworking, communication and maintaining trust, is difficult but necessary to confirm competence and to alert trainees and trainers of potential problems before they become intractable. This study used 360° team observation reports for this purpose. The process was easy to administer and valued by trainees.

A computerized monitoring system of senior house officers' evaluations of their education and training has been developed in the West Midlands. Four successive surveys over 2 years show some significant improvements in their education and training.

Multi-source feedback, or 360-degree assessment, is an important part of the assessment of people in the workplace, in both health and industry. Almost all published work concentrates on content validity and generalizability. However, an assessment system needs construct validity, and has to have practicability and acceptability, without sacrificing fitness for purpose, content validity or inter-rater reliability. This was a six-year study of the first UK-wide hospital-based multi-source feedback system, in the specialty of obstetrics and gynaecology. This paper describes the development of the assessment tool, its use and the analyses of the results in several areas. These are picking up poor performance, congratulating good behaviour, construct validity, the number of domains to be measured, and the minimum number of raters. The study demonstrated that the Team Observation system in reality only measured a very limited number of attributes, and that the main construct under scrutiny is interpersonal behaviour. The system can identify those who may have a problem, using less than 10 raters, and yet the process can be a positive experience for the large majority of people who have been assessed.

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