Faculty Development
WORKPLACEBASED
ASSESSMENT
www.londondeanery.ac.uk
COURSE OBJECTIVES
By the end of the course participants will have:
• Described the educational principles that underpin workplace-based assessment (WPBA)
• Discussed key issues in the implementation of WPBA
• Compared types of assessment in common use
• Considered the use of WPBAs to develop proficiency in trainee practice
• Explored ways to use WPBAs as developmental opportunities and to aid reflection
WORKPLACE-BASED ASSESSMENTS
• Experiences – Of using WPBAs
• Challenges – What are the limitations and challenges of the current system of WPBA?
• Constraints – What prevents learners and trainers from maximising effectiveness?
• Opportunities – What educational opportunities arise from their use?
TRAINEE-REPORTED CHALLENGES
• Lack of clear role/responsibility
• Knowing what is expected of them
• Competing demands on time
• Limited opportunity to be observed or to receive feedback
• Unclear about immediate relevance of WPBAs
LEARNING IN POSTGRADUATE TRAINING
Traditional approaches:
WPBAs tools:
• Immersion
• Professional knowledge – cases,
reasoning
• Case-based discussion (CBD)
• Professional skills – history/exam
• Directly observed procedural skills (DOPs)
• Technical skills – procedures
• Multi-source feedback (MSF)
• Professional socialisation – attitudes and
behaviours
• Continuing professional development
• Mini clinical evaluation (CEX)
WHY DO WE ASSESS?
• Patient safety and standards of care
• To ensure we are training correctly
• To develop trainees
WHAT IS ASSESSMENT?
• ‘A systematic procedure for measuring a trainee’s progress or level of achievement
against defined criteria to make a judgement about a trainee’ (GMC 2010)
• A check of the learning that has taken place
• ‘About getting to know our students and the quality of their learning’ (Rowntree 1977)
TYPES OF ASSESSMENT
• Formative – Aids learning through constructive feedback
• Summative – Determines levels of competence for progression
• Appraisal – Formal review of progress
Professional authenticity
AUTHENTICITY OF CLINICAL ASSESSMENT –
MILLER’S PYRAMID
Miller (1990)
Does
Behaviour
Shows how
Knows how
Cognition
Knows
MILLER’S PYRAMID – 1990
Does
Actual performance
assessment (WPBA)
Shows how
Procedural competence
assessment (OSCE), simulation
Knows how
(Clinical) context-based tests,
MCQ, essays
Knows
Factual tests, MCQ,
essays
WHAT DO WE ASSESS?
Case-based discussion
(CBD)
360º appraisal (360)
Direct observation of
procedures (DOPs)
Clinical
knowledge and
skills
Practical skills
Interpersonal
skills and
judgement
Professional
behaviours
Direct observations of
non-clinical skills
(DONCS)
WHAT DO YOU WANT FROM ASSESSMENT?
• Clear purpose
• Fair
• Clearly related to the learning that has taken place
• Tests what should be assessed rather than what is easy to assess
• Helps to improve performance if formative, or reliably sorts out the pass from the
fail if summative
• Multi-faceted
• Reliable
WORKPLACE-BASED ASSESSMENT
• Assessment for learning (formative)
• Assessment of learning (summative)
• Learning is at its most powerful when it is authentic (workplace)
• Valid but not always reliable assessor (subjective versus objective)
• Reliability when part of many
• Learning by doing, reviewing, reflection
FORMATIVE AND SUMMATIVE
ARCP
Reports from
Educational
supervisors
CEX, DOPs, PBAs, OSATs,
CBDs, PATs, TABs, MSFs
FORMATIVE AND SUMMATIVE
ARCP
6
5
4
Mid
WPBAs
3
2
1
Early
WPBAs
Late
WPBAs
TRAINEES SHOULD BE ‘SAFER’
• Spread assessments through job
• As many assessors as possible
• Feedback as well as scores
• Evidence it all (follow-up actions)
• Reflect on what they do
CONSCIOUSNESS
WORKPLACE-BASED ASSESSMENT
Conscious competence
(C/C)
Conscious
incompetence
(C/IC)
Unconscious incompetence
(UC/IC)
COMPETENCE
Unconscious competence
(UC/C)
WORKPLACE-BASED ASSESSMENT
3. What could you improve?
C/C
C/IC
CONSCIOUSNESS
1. What do you think you did well?
4. I think you could improve…
UC/IC
2. I think you did well at…
UC/C
COMPETENCE
FEEDBACK
‘Giving feedback is not just to provide a judgement or evaluation. It is to provide
[develop] insight. Without insight into their own limitations, trainees cannot process
or resolve difficulties’
(King 1999)
FEEDBACK
• Allows an individual to identify what they have done/are able to do effectively
• Gives suggestions about alternative approaches to a task to improve effectiveness
• Allows the learner to identify ongoing learning needs
• Both challenges and supports the subject
FEEDBACK DOS AND DON’TS
Do
Don’t
Do it close to the observation
Avoid inappropriate place/time
Describe the specific behaviour
Judge the person
Only comment on what you see
Generalise
Give examples of what was good and why
Break confidentiality
When identifying areas for improvement
suggest alternatives
Be vague
Give follow-up actions for development
Avoid specifics
GIVING FEEDBACK – REFLECTION
• How do you think it went? (insight check)
• What went well?
• Examples of the good
• What could be improved/how?
• ‘I noticed…’
• ‘If you were doing it again…’ (ask/suggest)
Describe gap between current and desired performance
Agree a plan and how to get there
WORKPLACE-BASED ASSESSMENT
WBA
Competencies
Examples of Assessors
Setting
Mini-CEX
Communication with patient,
physical examination, diagnosis,
treatment plan
Educational/ Clinical Supervisors,
senior trainee
Clinic, A&E, ward,
community
CBD
Clinical judgement, clinical
management, reflective practice
DOPs
Technical skills, procedures
and protocols.
Mini-PAT
MSF
TAB
Team-working,
professional behaviour
Trainee’s MPT
Multiple areas covered
by MPT
PBA/OSAT
Technical skills, procedures and
protocols, theatre team-working
Consultant or ST5 + trainee
Clinic, A&E, ward,
theatre
Educational/ Clinical Supervisors,
senior trainee
Educational/ Clinical Supervisors,
senior trainee
multi professional team (MPT)
Multiple areas covered
by a challenging case
Clinic, A&E, ward,
theatre
CLINICAL SKILLS
• What kinds of clinical skills do trainees need to develop?
• Where do they have a chance to do this?
• When in your working week can you offer the opportunity to develop trainees’
clinical skills?
• How can this be recorded and used to develop trainees?
MINI-CEX
MINI-CEX – ALL IN A DAY’S WORK
•
History taking
•
Physical examination
•
Communication
•
Clinical judgement
•
Professionalism
•
Organisation and efficiency
5 – above expectations
•
Overall clinical care
6 – above expectations
The bulleted areas are to be
rated as one of the following:
1 – below expectations
2 – below expectations
3 – borderline
4 – meets expectations
MULTI-SOURCE FEEDBACK
• Trainee-centred:
‘How do you think you are settling in?’
‘What sort of feedback do you think you have had?’
‘What do you think about what I have said?’
• Balanced:
Strengths from MSF/last post before concerns
Provides possible explanation for poor comments
Personally values confidence
• Seeks specifics:
‘Why do you feel we don’t value confidence?’
Asks for reasons for the comments
‘Can you think of a situation where a clinical decision you made…’
MULTI-SOURCE FEEDBACK
• Clarifies difficult areas:
‘Do you think some people may not feel valued as part of the team?’
‘I think it’s an important thing for you to do’ (ask others)
• Action plan:
Reflective case-based discussion next week
Action plan
• Perspective/Honesty:
Re the issues
Re the possible outcome
PRACTICAL
In pairs:
• One assumes role of supervisor
• One assumes role of trainee
• Using the data for Dr M and Dr K, feed back the results of the MSF to one another
• Two sessions of 10 minutes each
CASE-BASED DISCUSSION
• What benefits are offered by case-based discussion (CBD)?
• Where can CBDs take place?
• When can they happen?
• Who can be involved?
CASE-BASED DISCUSSION
CASE-BASED DISCUSSION – TYPES
• Short case/long case/viva
• Knowledge-based
• Management of patient
• Multi-disciplinary team
• Decision making
• Ethical
• Reflection
• Developmental change
CASE-BASED DISCUSSION – AREAS
• Medical record keeping
• Clinical assessment
• Investigation and referrals
• Treatment
• Follow-up and future planning
• Professionalism
• Overall clinical care
CASE-BASED DISCUSSION – SUMMARY
• Summative and formative components
• Based on what has happened not what would happen
• Explores reasoning
• Questioning to ‘dig deep’
• Promotes learning and new insights if used well
• Just ticks the boxes if done badly
TAKING IT BACK TO PRACTICE
• What have you learned today about WPBAs – key messages?
• Where, when and how will you be involved in WPBAs?
• In what ways could you plan more effective ‘supervised learning experiences’ for trainees
with identified learning needs?
• How will you encourage documentation of learning?
RECORDING LEARNING
• Reflective writing
• Log book
• Portfolio
• Evidence of: teaching, presentations, observation notes, peer discussions, journal clubs,
e-learning, multi-disciplinary teams, leadership, etc.