Introduction to Workplace-based Assessments

Dr Hani Zakhour

Director of Training and Educational Standards

The Royal College of Pathologists

19 October 2007

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History I

PMETB Standards for postgraduate training and

assessment were published in 2005 Training and assessment should be much

more integrated – an assessment system Clear view of PMETB and GMC (joint paper

2005) that these should include continuous monitoring not just periodic College examinations

Workplace-based assessment” PMETB Jan 2005

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History II

RCPath College has been fully engaged with reforms

in Medical Education January 2005, College Council witnessed a

presentation of RCP pilot of WBA, tools were commended by Council

Director of Examinations and Assessment May 2005

WBA Manager appointed October 2005 WBA Working group March 2006

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PMETB principle documents

Standards for Curricula Janet Grant Chair Curriculum Sub-Committee Sue Fox, Namita Kumar, Ewen Sim, Members Curriculum Sub-Committee

Revised March 2005 Principles for an assessment system for

postgraduate medical TrainingLesley Southgate Chair Assessment Committee Janet Grant Chair Curriculum Sub-Committee 14 September 2004

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Test methods as part of the blueprint

Test methods for assessment programmes can only be selected once the purpose and content are established What is the best trade-off between fidelity and

efficiency. What is the programme for writing and refining test

material? How are marking schedules developed and reviewed

where relevant? Is new test material piloted before it is used?

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How will the assessments be collated?

Assessment tools will build up a profile as the year progresses

Evidence of a response to feedback will be shown by subsequent assessment of the same area

Overall record will form the basis for a submission to the deanery as evidence of satisfactory completion of the year ARCP

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Standard Setting

It is only possible to set a sensible standard if the purpose of the assessment is clearly set out.

The most important thing about a standard is who sets it

It is the standard expected of trainee at the end of a particular stage Understanding principles of the specialty and

practices under direct supervision (Stage A) In-depth knowledge and understanding of principles

and practices of the specialty (stage D)

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Standardisation

Commonality in the standards that are required of trainees.

Grade descriptor, intended as a guide Grade scale

1,2 - Below expectation 3 - Borderline 4 - Meets expectations 5,6 - Above expectations

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Tools

Tools taken from F2 programme CbD Case-based Discussion (Dame Lesley Southgate)

used to enable the documenting of conversations about, and presentations of, cases by trainees

DOPS Directly Observed Procedural Skills (RCP) a method, similar to the Mini-CEX that has been designed

specifically for the assessment of practical skills. MiniCEX Mini Clinical Evaluation Exercise (John Norcini)

designed to provide feedback on skills essential to the provision of good clinical care by observing an actual clinical encounter

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Tools

Tools taken from F2 programme MSF Multi Source Feedback - ePath SPRAT (Dr Helena

Davies) provides feedback from a range of co-workers across the

domains of Good Medical Practice. These can be mapped to the core objectives of the curriculum

ECE Evaluation of Clinical Events (WBA Group Histopathology) It replaces MiniCEX for Histopathologists

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Purpose of Assessment Tools To assess what cannot be assessed by an

examination. CbD

Indicates trainees’ capability, potential and behaviour Provides immediate feedback on trainee’s learning

needs highlighting strengths and identifying weaknesses

DOPs Indicates trainees’ acquisition of practical skills and

understanding of equipment Indicates trainee interacts appropriately with patients

MiniCEX Indicates trainees’ acquisition of clinical skills

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Pitfalls of WBA

To avoid time-consuming “busy” assessment forms, the assessments are often simplified if not simplistic computerised forms can over-simplify complex

judgements

A robust rating can only occur if there are a number of independent observers – which can be difficult in small specialties

They have only been validated in a number of clinical settings but not in all pathology settings

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Beware!

Test methods can only be selected once the purpose and content are established What is the best trade-off between fidelity and

efficiency. What is the programme for writing and refining

test material? How are marking schedules developed and

reviewed where relevant? Is new test material piloted before it is used?

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Principles of conduct for WBA

Assessment based on performance in the workplace and measured there

Observations can be combined from a number of assessors to provide a robust rating for the candidate

Assessment occurs during normal work immediately followed by feedback on their routine performance

WBA is not cast in stone – work in progress and subject to improvement following evaluation

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Who can be an assessor?

Assessors can be consultants who are supervisors as well as staff of all grades in contact with the trainee Clinical Scientists Nurses BMS Senior trainees Autopsy room staff and others

No need for prior approval by RCPath Need to follow WBA guidelines and are willing to

engage in the process

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Who is it for?

Mandatory for all StRs (Specialty Registrars) appointed from August 2007 to one of the following: Specialty training programme with a National Training

Number (NTN) Fixed Term Specialty Training Appointment (FTSTA) Locum Appointment for Training (LAT)

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Feedback

One of the most important aspects of any assessment programme is the effect it has on learning and preparation for individuals and the profession.

How is feedback given to individuals and groups about the outcomes of an assessment?

Finally the mechanisms for appeal about the outcome should be documented and reported.

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Present and future

2007 – Launch of tools and paper-based assessment forms.

2008 – Launch of web-based system Use data generated by all assessments

including MSF and OSPE for validation Ensure compliance with MMC Gold Guide

and planned ARCP

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Acknowledgments

Sandra Dewar Dr Trevor Gray Dr Mary Thompson

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Tribute

Professor Dame Lesley Southgate

Professor Janet Grant

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