What is Work place based assessment (WBA)?
The primary purpose of WPBA
is to provide short loop feedback between trainers and their trainees – a
formative assessment to support learning. They are designed to be mainly
trainee driven but may be triggered or guided by the trainer.
What is the Purpose of WBA?
Several
purposes of WBA has been identified. WBA helps to form a comprehensive
assessment system, blueprinted to important curriculum requirements. It
also provides educational
feedback on which to reflect and develop practice. Another purpose of
WBA is it provides a reference
point on which to compare past, current and future levels of competence. WBA
also supports remedial / targeted training and Provides evidence of progression. At the
end of WBA it informs
summative assessment
Benefits of WBA
Main benefit of WBA is it has a strong educational impact.
Availability of clinical materials and skilled teachers are other benefits of
WBA. Some other benefits of WBA are,
• WBA is 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
Position of work place based assessment in Miller’s Pyramid
Preparation for WBA
First most important fact in WBA is Patient consent and safety must be
assured by the assessor. Also the assessors should be trained in the tool and have expertise in the area
being assessed. Reliability of assessing can be improved by using on a range of different assessors.
It Should be used in different
settings with different cases.
Use of WBA
• 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
• 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
• 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
• 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
• 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
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
Types of Work place based
assessments
Mini Clinical Examination (CEX)
The CEX traditionally involved
observation of the trainee carrying out a thorough history taking and physical
examination and presenting their findings and diagnosis, and a written report
of conclusions for the supervising clinician to evaluate.
—
Case-based
discussions
Case-based discussion (CbD) in medical Foundation Training
is a structured discussion with an assessor of clinical cases managed by the
foundation doctor. Its strength is assessment and discussion of clinical
reasoning. The foundation doctor selects two case records from patients they have
seen recently, and in whose notes they have made an entry. The assessor selects
one of these for the CbD session. The discussion starts from and is centred on
the foundation doctor’s own record in the notes. CbD assesses medical record
keeping, clinical assessment, investigation and referral, treatment rationale,
follow up and future planning, professionalism and overall clinical care.
Feedback is provided to the trainee immediately following the discussion.
—
Direct
Observation of Procedural Skills (DOPS)
Direct observation of procedural skills (DOPS) has been
defined as the observation and evaluation of a procedural skill performed by a
trainee on a real patient. Procedural skills are also known as technical or
practical skills. Evaluation by an experienced practitioner is carried out
using either a checklist of defined tasks, a global rating scale, or a
combination of both.
—
360
Degree assessment
Multiple
assessors Including senior colleagues, nurses, AHPs is done. This includes the
self assessment as well. Student would be assessed for their routine
performance. Ultimately the feedback is reviewed with trainee and supervisor on agreed action plan.
—Portfolios
Snadden (1998) describes a portfolio as “a collection of
evidence that learning has taken place which in practice includes documentation
of learning and progression, an articulation of what has been learned, and a
reflection on these learning events/experiences.” Portfolios are used both as a
learning tool to stimulate reflective, experiential and deep learning and as an
assessment method to judge progression towards or achievement of specific
learning objectives, competencies or fitness to practice. Depending on the
specialised purpose of the portfolio, its content including evidence required,
and assessment criteria vary from context to context. Any portfolio that is
used for assessment purposes should clearly articulate the amount, type and
quality of evidence required to establish proof of competence and the marking
criteria used to evaluate the quality of the evidence.
