ReviewGetting lost in translation? Workplace based assessments in surgical training
Section snippets
Workplace based assessments
WBA is ‘assessment of working practices based on what trainees actually do in the workplace, and predominantly carried out in the workplace itself’.6 The ISCP requires trainees to complete a range of assessments: ‘mini clinical evaluation exercises (mini-CEX), case-based discussions (CbD), direct observation of procedural skills (DOPS), procedure based assessments (PBA's) and 360° appraisals using a multi-source feedback tool (MSF). WBA's are designed to integrate teaching, learning, assessment
Reliability demands that multiple assessments be performed
Accurately assessing the performance and skills of doctors in training remains a significant challenge.10 One question often asked of WBA's is how reliable they are – that is their reproducibility. Three factors are thought to impact upon reliability: the number of encounters observed, the number of assessors and the aspects of performance being assessed.11 It has been recognised that doctors' performance is case specific and poorly predictive of performance in other cases.12 A result of this
Trainees view WBA's as ‘tick-box’ exercises which leads to their misuse
Even as early as 2004, a study concluded that surgical training is being negatively impacted upon by WBA's due to the considerable administrative burden.14
This has been followed by a large independent survey of surgical trainees published in 2009 which highlighted the dissatisfaction of surgical trainees with the administrative burden placed on them by the WBA's they were required to undertake.15 The survey identified that 82% of trainees felt that the time taken to complete the required number
Lessons to be learnt from the Foundation Programme
A comprehensive review of the Foundation Programme has been recently performed. Regarding WBA, Collins concluded that the number of assessments required was ‘formidable’, and that urgent review should be made into their frequency.20 The number of assessments required of surgical trainees is now much greater than that required at the time of this review of the Foundation Programme. It would appear a logical extrapolation that the same conclusion would therefore be true of surgical training, that
Are ‘supervised learning events’ the answer?
Although lack of time is clearly an issue, trainees lack understanding of the educational theories underpinning the use of WBA's, and the benefit of full engagement in the formative assessment process, which is why they are viewed by many as tick-box, summative exercises.16, 22
Trainers too, must possess understanding of the purpose, timing and frequency of WBA's to ensure the tools are implemented correctly.23 However, engagement with training in the use of WBA's can be very low – just 11.5% of
Conclusion
Workplace based assessments are an integral part of surgical training in the UK. Unfortunately, they are negatively viewed, on the whole, by trainees – predominantly because of the administrative burden that is placed upon an already time constrained training programme. The GMC's view that WBA's should be formative learning events is rarely realised and the tools are commonly misused. This may be partly due to time constraints, but full understanding by trainees and trainers of WBA educational
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