Workplace assessment Dr. Kieran Walsh, Editor, BMJ Learning. 2

Workplace assessment – pluses Lots of clinical material available Skilled clinicians/teachers available Strong educational impact 3

Workplace assessment – potential difficulties Broad range of problems/patients/procedures required Integrated skills Potential to practice Specific assessment experience/expertise is often rare Small number of trainees in each discipline in an average sized hospital 4

Workplace assessment – theory Knows Knows how Shows how Does 5

Workplace assessment – judgement based on…. Single encounter Actually observed performance Case specific Routine performance Observation over a period on different occasions on different problems Reduces problems with case specificity 6

Workplace assessment – nature of judgement Did it happen? Checklist approach Objective Structured Consistent But not very discriminatory 7

Workplace assessment – nature of judgement Was the trainee any good? Global rating More valid 8

Workplace assessment – nature of judgement Was the trainee good enough for a particular purpose? 9

Workplace assessment – influence on learning Formative assessment and feedback Direct observation (in the past many trainees never observed in a patient encounter) 10

Workplace assessment – faculty development Workshops needed Training in behavioural observation Performance dimension training Frame of reference training 11

Workplace assessment – reliability Number of encounters observed Number of assessors Aspects of performance being assessed 12

Workplace assessment – is it a fair test? Different patients Different assessors Faculty development Common problem list Number of assessors for each trainee 13

Workplace assessment – stakes Assessments influenced by what is at stake Colleagues reluctant to make negative assessment when stakes are high BUT External examiners Faculty development Anonymity in peer assessment Should trainees choose their assessor? 14

Workplace assessment – costs Planning Time of trainees and assessors Real patients Training of both groups Administration Material Collating and processing results Training Cost effective?? If used for correct purpose 15

Workplace assessment – CbD Case based discussion Trainee selects case studies, assessor chooses one of these Assessor should ask why this selection Assesses quality of … diagnosis, assessment, management, record-keeping 15 minutes (5 minutes for feedback) 16

Workplace assessment – MiniPAT Peer assessment tool 8 assessors Including senior colleagues, nurses, AHPs Including self assessment Routine performance Feedback reviewed with trainee and supervisor Agreed action plan 17

Workplace assessment – MiniCEX Faculty member observes a trainee interacting with a patient in a clinical setting 15 minutes (+5 minutes for feedback) Interviewing skills, physical exam, professionalism, communication skills Formative feedback 18

Workplace assessment – MiniCEX Not for high stakes exams Not to rank trainees Not to compare training programmes 4-6 times in the year Different assessor each time Encounter chosen by the trainee, confirmed by the assessor 19

Workplace assessment – DOPS Direct observation of procedural skills Real patients 15 minutes (+ 5 minutes feedback) Trainees select from an approved list of procedures Indications, communication, technique, analgesia, asepsis 20

Workplace assessment – DOPS 6 times in the year Valid Global rating scales 21

Workplace assessment – portfolios Different types of information Summary of educational experiences Reviewed by an assessor Reflection Action plan Purpose must be clear (e.g. for summative use) Need be specific about what portfolio should contain 22

Workplace assessment – screening If you do really well on your first 2 MiniCEX’s, how will you get on in your next 4? 23

Workplace assessment – checklists vs global ratings? Scores are broadly correlated Checklists – objective, reliable, lower level of expertise Global ratings – subjective, more valid Only experts can use global ratings Anyone can be trained to use a checklist 24

Workplace assessment – references and further reading Norcini JJ. Workplace assessment. In Understanding Medical Education: Evidence, Theory and Practice. ASME 2010 Miller A, Archer J. Impact of workplace based assessment on doctors' education and performance: a systematic review. BMJ. 2010 Sep 24;341 Van Tartwijk J, Driessen EW. Portfolios for assessment and learning: AMEE Guide no. 45. Med Teach. 2009 Sep;31(9):790-801. Norcini J, Burch V. Workplace-based assessment as an educational tool: AMEE Guide No. 31. Med Teach. 2007 Nov;29(9):855-71. Wilkinson TJ. Assessment of clinical performance: gathering evidence. Intern Med J. 2007 Sep;37(9):631-6. 25