Work place based assessments

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.

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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.

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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.

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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.