Elsevier

The Surgeon

Volume 11, Issue 5, October 2013, Pages 286-289
The Surgeon

Review
Getting lost in translation? Workplace based assessments in surgical training

https://doi.org/10.1016/j.surge.2013.03.001Get rights and content

Abstract

Workplace based assessments (WBA) are integral to the competence-based surgical training curriculum that currently exists in the UK. The GMC emphasise the value of WBA's as assessments for learning (formative), rather than as assessments of learning (summative). Current implementation of WBA's in the workplace though, is at odds with their intended use, with the formative functions often being overlooked in favour of the summative, as exemplified by the recent announcement that trainees are required to complete a minimum of 40 WBA's a year, an increase from 24. Even before this increase, trainees viewed WBA's as tick-box exercises that negatively impact upon training opportunities. As a result, the tools are commonly misused, often because both trainees and trainers lack understanding of the benefits of full engagement with the formative learning opportunities afforded by WBA's. To aid the transition in mind-set of trainees and trainers to the purpose of assessment in the workplace, the GMC propose the introduction of ‘supervised learning events’ and ‘assessments of performance’ to supersede ‘WBA's’. The impact of this change and how these will be integrated into surgical training is yet to be seen, but is likely to be a step in the right direction.

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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