Workplace-based
Assessment
Overview
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Types of assessment
Assessment for learning
Assessment of learning
Purpose of WBA
Benefits of WBA
Miller’s Pyramid
Preparation for WBA
Use of WBA
Criteria for feedback
Barriers to WBA
Utility
The learning environment
Types of assessment
Assessment for learning
Assessment of learning
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Assessment for learning
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Alternative terms are Formative or Low-stakes assessment
Assesses performance (does)
Ideally undertaken in the workplace
Primarily aimed at aiding learning through constructive
feedback
• Undertaken frequently to increase reliability
• Identifies areas for development to help trainees learn and
develop
• Contributes to summative evidence for judgements on trainee
progress
Assessment of learning
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• Alternative terms are Summative or High stakes assessment
• Assesses competence (can do)
• Primarily aimed at determining a level of competence to permit
progression of training or certification
• Include examinations and AES end of placement reports
• High reliability and can be undertaken infrequently
• Form the basis of pass/fail decisions
Purpose of WBA
• Helps form a comprehensive assessment system, blueprinted
to important curriculum requirements
• Provides educational feedback on which to reflect and
develop practice
• Provides a reference point on which to compare past, current
and future levels of competence
• Supports remedial / targeted training
• Provides evidence of progression
• Informs summative assessment
• Contributes to a body of evidence for the ARCP
Benefits of WBA
• Based on observable performance and specific criteria
• Encompasses skills, knowledge, behaviour and attitudes
including judgement and leadership
• Provides descriptors to aid the assessor’s judgement
• Samples across important workplace tasks
• Encourages trainee/trainer dialogue
• Can identify those in need of additional support
• Encourages reflection to improve practice
• Provides a personal trajectory of progress
• Indicates readiness for summative tests
Miller’s Pyramid
Does
Shows how
Knows how
Knows
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Workplace based assessment
OSCEs, clinical and practical examinations
MCQs,
Short answer questions,
Essay questions
Preparation for WBA
• Patient consent and safety must be assured by the assessor
• Assessors should be trained in the tool and have expertise in
the area being assessed
• Should draw on a range of different assessors
• Should be used in different settings with different cases
Use of WBA
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Trainee led and trainer guided
Structured forms should inform debriefing
Feedback immediately after observation
Written feedback should describe performance
WBA should be followed by reflection by the trainee
Use more often for trainees who need remedial support
Judge the trainee against the standard at the end point
The interaction between trainee and trainer is key
Trainee role
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Triggers WBA, in line with the LA
Puts the safety of the patient first
Agrees case and time with assessor in advance
Ensures sufficient WBAs are completed throughout
placement
Uploads to the portfolio comments accurately within 2
weeks of assessment
Respects confidentiality of patients and colleagues
Reflects on feedback
Follows up action plans
Assessor role
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Must be appropriately qualified in the relevant discipline
Must be trained on the WBA method
Ensures consent and safety of patient
Carries out observation and provides feedback
Completes / checks online form and signs to validate
Keeps the AES informed of issues or concerns
Criteria for feedback
There should be a written record describing performance to look
back on.
Good quality feedback should:
• Reinforce what was done well
• Explain areas for development
• Suggest appropriate corrective action
Barriers to WBA
Barriers to using WBA
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Unintentionally seen as
threatening (e.g. as mini-exams)
Low ratings are seen as failures by
trainees (and some trainers)
Lack of trainer time, especially
senior trainers
Actions to overcome barriers
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Provide faculty development and
trainee induction
Promote WBA as opportunities for
learning
Written feedback puts ratings in
context
Low scores should be seen as the
norm early on
Provide time in job plans for those
in key roles to use WBAs and
discuss concerns
Utility of assessment
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Refers to the relative value of using a type of assessment.
The criteria are:
• Reliability
• Validity
• Acceptability to users
• Feasibility of use
• Educational impact
It is unlikely that one assessment type will cover all these areas
The challenge is to improve the utility of all types of assessment
to enhance the overall assessment system.
Reliability
Enhanced by:
• Assessor training
• Use of a range of assessors
• Use of all WBA methods
• Use of WBA frequently
• Triangulation with other assessments
Validity
Enhanced by:
• Blueprinting to curriculum and GMP
• Linking WBA with clear objectives within a
structured a learning agreement
• Direct observation of workplace tasks
• Increasing complexity of tasks in line with
progression through the training programme
Acceptability
Enhanced by:
• Providing assessor training and trainee
induction to enhance understanding of criteria,
standards and methods
• Interaction between trainee and trainer
Feasibility
Enhanced by:
• Linking WBA with clear objectives, standards
and a structured learning agreement
• Assessing what trainees would normally do in
training situations
• Working feedback into normal dialogue
Educational Impact
Enhanced by:
• Supervised training and appraisal
• Clear objectives and learning agreement
• Learning opportunities
• Good quality feedback
• Reflection on feedback
The Learning Environment
An environment that supports learning will:
• Ensure everyone understands and values their role and that
of others in the educational process
• Provide faculty development and trainee induction
• Make time for training and assessment
• Encourage performance beyond competency; an aspiration to
excellence
• Encourage the development of reflective practitioners
• Provide professional educational support
• Support trainers in making difficult decisions or negative
judgements
• Support for trainees in difficulty
References
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GMC Workplace Based Assessment - A guide for implementation
Miller, G.E. 1990. The assessment of clinical
skills/competence/performance. Academic Medicine, (65), pp. S63-7.
Van der Vleuten, C.P.M. and Schuwirth, L.W.T. 2005. Assessing
professional competence. Medical Education Vol. no. 39, pp 309-17.
Further reading:
• GMC: Learning and assessment in the clinical environment: the way
forward – November 2011
http://www.gmc-uk.org/Learning_and_assessment_in_the_clinical_environment.pdf_45877621.pdf