PAEDIATRIC RESPIRATORY MEDICINE: ASSESSMENT GUIDANCE
AIM OF THE ASSESSMENTS
Reassuring the individual, the profession and the public, as well as employers and regulatory
bodies that a trainee is fit to practise.
THE EDUCATIONAL PURPOSES FOR THE ASSESSMENT SYSTEM ARE:
1. To support learning and progression across the curriculum.
2. To assess the level of competence achieved at different stages of the training.
3. To produce level 3 competency Paediatric Respiratory Consultant.
The assessment system is to be used to reassure the trainee and provide the trainee with feedback
about their own knowledge, skills and attitudes and the opportunity to show progression and
development through their training programme.
In order to achieve this, all areas of the training curriculum need to be sampled and assessed in the
most appropriate ways, according to the nature of the knowledge or skill being assessed.
The aim at level 3 the trainee is learning to work independently within team and developing further
many of the non-technical competences which will be assessed through Portfolio and the range of
workplace based assessments. Trainees will be developing expert clinical reasoning, which makes
CbD particularly valuable at this stage.
The core assessment instruments for level 3 trainees are:
1. Portfolio
2. Workplace based assessment
3. Trainer Report
The purpose of the individual assessment instruments within the system will therefore vary.
1. PORTFOLIO
The portfolio will underpin learning from the curriculum and act as a platform for trainers and
trainees to manage various elements of professional development and assessment required. It will
be compiled by the trainees throughout the three years of training period.
The portfolio will contain:
Professional development plan (after discussion with the trainers)
Skills log
Record of training events
Trainer reports
Reflective events
Teaching and presentation
Audit/research
Clinical ethic and safety/quality issues (QA project, clinical audit etc)
2. ASSESSMENT OF PERFORMANCE
a. MSF (multisource feedback)
The Sheffield Peer Review Assessment Tool, originally validated for use in paediatrics (Archer 2005),
has been adapted to each level of training in Paediatric Respiratory. This instrument is invaluable for
assessing a trainee’s performance over time, in everyday practice.
It provides multi-source feedback, also known as 360° assessment (MSF). The reliability and validity
of MSF has been evaluated in its development and implementation stage, and it has proved to be a
robust assessment tool. MSF generates structured feedback which can be used as part of personal
development planning.
A minimum of 2 assessments are required per year. If during the first year training, the trainee did
not obtain a single satisfactory assessment, it should be brought up to the Paediatric Respiratory
Sub-Speciality Committee to decide on further action.
b. MiniCex (Mini Clinical Evaluation Exercise)
(Holmboe 2003,2004 & Norcini 2005). The instrument has been modified to map to paediatric
respiratory assessment standards. MiniCeX is a workplace based assessment tool designed to
provide feedback on skills essential to the provision of good clinical care. The instrument enables us
to assess trainees in real patient encounters.
In keeping with a quality improvement assessment model, strengths, areas for development and
agreed action points will be identified following each Mini -CEX encounter. It samples a range of
areas within the assessment standards and can be mapped to Good Medical Practice.
Mini-CEX is suitable for use in an out-patient, in-patient or acute care setting. The assessor must
have actually OBSERVED the part of the encounter they are rating. It is not designed to assess a
reported encounter.
Example of suitable encounters could include:
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Examination of a patient and explanation of the findings on the ward round
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Initial history taking for a patient who is newly admitted
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Review of a patient with a chronic illness such as CF
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A trainee demonstrate a variety of inhaler devices to parents and children and select
appropriate devices for clinical situation

Interpret CXR and CT chest
Immediate feedback will be provided after each encounter by the assessor rating the trainee
focusing on aspects of the discussion of the encounter where the trainee did especially well
(anything especially good), suggestions for development and any agreed action should be provided
and documented.
A minimum of 4 assessments are required per year. If the assessment is not satisfactory, it has to be
repeated within that 3 months posting.
c. CbD (Case-Based Discussion)
(Davies 2005 & Davies 2005). The instrument developed has been modified to map to paediatric
respiratory assessment standards.
CbD is a workplace based assessment tool for paediatric respiratory trainees that have been
designed to assess clinical reasoning skills and the ability to bring an analytical approach to diagnosis
and management of paediatric respiratory conditions. It allows trainees to discuss why they acted as
they did.
Ideally half the cases should be selected by the trainee and half by the assessor. The cases selected
should cover a range of clinical problem areas and should be cases that reflect their stage of training.
Discussion should be based on the entry made in the notes and exploring the thought processes that
underpinned the entry. It should not be seen as an opportunity to conduct a viva but should be seen
as an opportunity to explore their clinical reasoning and decision making.
A few possible questions are set out below to provide an example of the sort of style of questioning
that is effective:
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What was going through your mind when you wrote that management plan, just talk me
through your thought process?
I see that you have written down a number of different investigations – how did you think
the results would help you work out what was going on and what you needed to do?
You have referred to the ward guidelines in your notes – tell me a bit about how you used
the guidelines to help plan management and whether there were any aspects that didn’t fit
in this case?
I see that you have decided to treat child with xx – talk me through how you decided to
prescribe that regime and what the alternatives you considered were?
You have written down that you were going to ask Dr X for their advice – what specifically
did you want to discuss with them, why was it important in this case, how did their advice
help and what did you learn from it?
The discussion must start from and be centred on the trainee’s own record in the notes. Following
discussion of the case the assessment record should then be filled out. Immediate feedback focusing
on aspects of the discussion of the case where you felt the trainee did especially well (anything
especially good), suggestions for development and any agreed action should be provided and
documented.
A minimum of 4 assessments are required per year. If the assessment is not satisfactory, it has to be
repeated within that 3 months posting.
d. SAIL (Sheffield Assessment Instrument for Letters)
Sheffield Assessment Instrument for Letters (SAIL) has been developed and validated for use in
paediatrics (Crossley 2001 Fox 2004). SAIL is a workplace based assessment tool designed to assess
clinic letters and other written communication. The instrument assesses a trainee’s competence in
written communications in everyday practice, over time
A feedback will be provided based on the written letter or other written communication by the
assessor rating the trainee focusing on where the trainee did especially well (anything especially
good), suggestions for development and any agreed action should be provided and documented.
A minimum of 4 assessments are required per year. If the assessment is not satisfactory, it has to be
repeated within that 3 months posting.
e. DOPs (Directly Observed Procedural Skills)
DOPS is a workplace-based assessment tool designed for the assessment of practical skills.
It is considered appropriate to assess most practical procedures and a range of practical procedures
have been identified for assessment.
Following discussion the assessment record should then be filled out by the assessor. Immediate
feedback focusing on aspects of the discussion where you felt the trainee did especially well
(anything especially good), suggestions for development and any agreed action should be provided
and documented
Minimum of one satisfactory DOPs assessment for each procedure listed in the log book.
3. TRAINER’S OVERALL ASSESSMENT REPORT
The report should be based on the trainee’s portfolio (including log book) and the tools used for
work-based assessment performance.
MSF:
MiniCEX:
CbD:
SAIL:
DOPs:
minimum 2/year
minimum 4/year
minimum 4/year
minimum 4/year
One for each procedure required in the log book
The trainee will be assessed every 6 months and during the first year of training, if there is no
satisfactory MSF/trainer’s report, the trainee should be assessed by a different Paediatric
Respiratory Consultant. If the assessment by second consultant remained unsatisfactory the
discussion should be made by the Paediatric Respiratory Sub-Speciality Committee to decide
whether the trainee is fit to continue in the training programme.
Adapted from Royal College of Physician and Child Health 2010.
Prepared on 190513