Workplace-based Assessment

Overview Types of assessment Assessment for learning Assessment of learning Purpose of WBA Benefits of WBA Miller’s Pyramid Preparation for WBA Use of WBA Criteria for feedback Barriers to WBA Utility The learning environment

Types of assessment 1 Assessment for learning Assessment of learning

Assessment for learning 1 Alternative terms are Formative or Low-stakes assessment Assesses performance (does) Ideally undertaken in the workplace Primarily aimed at aiding learning through constructive feedback Undertaken frequently to increase reliability Identifies areas for development to help trainees learn and develop Contributes to summative evidence for judgements on trainee progress

Assessment of learning 1 Alternative terms are Summative or High stakes assessment Assesses competence (can do) Primarily aimed at determining a level of competence to permit progression of training or certification Include examinations and AES end of placement reports High reliability and can be undertaken infrequently Form the basis of pass/fail decisions

Purpose of WBA Helps form a comprehensive assessment system, blueprinted to important curriculum requirements Provides educational feedback on which to reflect and develop practice Provides a reference point on which to compare past, current and future levels of competence Supports remedial / targeted training Provides evidence of progression Informs summative assessment Contributes to a body of evidence for the ARCP

Benefits of WBA 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

Miller’s Pyramid 2 Shows how Knows how Knows Does Workplace based assessment OSCEs, clinical and practical examinations MCQs, Short answer questions, Essay questions

Preparation for WBA Patient consent and safety must be assured by the assessor Assessors should be trained in the tool and have expertise in the area being assessed Should draw on a range of different assessors 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 Barriers to using 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 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 Actions to overcome barriers

Utility of assessment 3 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

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 The Learning Environment

References 1.GMC Workplace Based Assessment - A guide for implementation 2.Miller, G.E The assessment of clinical skills/competence/performance. Academic Medicine, (65), pp. S Van der Vleuten, C.P.M. and Schuwirth, L.W.T Assessing professional competence. Medical Education Vol. no. 39, pp Further reading: GMC: Learning and assessment in the clinical environment: the way forward – November