The view from here
Workplace-based assessments: lost in translation? Jason Ali, University of Cambridge, UK It is clear that WBAs are viewed by many trainees as simply ‘tick-box’ exercises
T
he General Medical Council (GMC), which governs medical training in the UK, emphasises the value of workplace-based assessments (WBAs) as assessments for learning (formative), rather than as assessments of learning (summative). Despite this, WBAs are relied upon to provide objective evidence of a trainee doctor’s competence and progression, leading to an emphasis being placed upon summative functions. This is further reinforced by the fact that the minimum number of assessments required of trainees seems to be increasing almost annually. From my own experience, and supported by the literature, it is clear that WBAs are viewed
by many trainees as simply ‘tick-box’ exercises that must be completed to progress in their career, and as such are not valued.1,2 This impacts significantly upon the educational opportunities afforded by the tools, as this commonly leads to their misuse. For example, it is not uncommon around the time of annual reviews of competence progression (ARCP) to hear colleagues asking seniors if they can e–mail a ‘directly observed procedural skills’ (DOPS) assessment or ‘case-based assessment’ (CbD) for a procedure or case that they may or may not have witnessed the trainee complete at some point earlier in the year. The fundamental problem with this is that the trainee
then misses out on the discussion and formative case-specific feedback from a senior colleague: a valuable educational resource to any trainee doctor and, after all, the primary intention of WBAs. In recognition of these problems, the GMC has recently suggested a change in terminology: a move away from simply WBA, suggesting that ‘supervised learning events’ (SLEs), the main purpose of which are formative, should be distinguished from ‘assessments of performance’ (AOPs), which have a summative function. They propose that by highlighting the formative nature of SLEs, trainees would engage with the learning opportunity afforded them.
68 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 68–69
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Personally, I question what impact simply changing the name of WBAs will have. From my own experience and discussions with trainee colleagues, I think that much of the problem lies with a lack of understanding possessed by both trainees and trainers as to the educational value and purpose of WBAs. Many of my trainee colleagues do not see WBAs as being for their benefit, and even see them as interfering with their training and professional development. This is a problem that requires a change in mindset to solve.
I wonder if this is because of a lack of training. I cannot recall a time that it has been explained to me that the purpose of WBAs is to aid my development as a trainee, but I vividly remember being told I must complete the minimum number to progress. The summative functions are emphasised at the expense of the formative. To ensure greater engagement of trainees and trainers with WBAs requires them to be educated, but also requires training programme leads and deaneries to move away from emphasising just the summative functions. Perhaps this training
should start at medical school so that doctors enter the workplace informed and enthusiastic to engage with WBAs in the way intended. REFERENCES 1.
Bindal T, Wall D, Goodyear HM. Trainee doctors views on workplacebased assessments: Are they just a tick box exercise? Med Teach 2011;33:919–927.
2.
Pereira EAC, Dean BJF. British surgeons’ experiences of mandatory online workplace-based assessment. JRSM 2009;102:287–293.
The summative functions [of WBAs] are emphasised at the expense of the formative
Corresponding author’s contact details: Mr Jason M Ali, Box 202, Addenbrookes Hospital, Hills Road, Cambridge, CB2 0QQ, UK. E-mail: [email protected]
Funding: None. Conflict of interest: None. Ethical approval: Not applicable. doi: 10.1111/tct.12085
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 68–69 69
tct_12085.indd 69
1/2/2014 11:09:26 AM
Workplace-based assessments: lost in translation? Jason Ali, University of Cambridge, UK It is clear that WBAs are viewed by many trainees as simply ‘tick-box’ exercises
T
he General Medical Council (GMC), which governs medical training in the UK, emphasises the value of workplace-based assessments (WBAs) as assessments for learning (formative), rather than as assessments of learning (summative). Despite this, WBAs are relied upon to provide objective evidence of a trainee doctor’s competence and progression, leading to an emphasis being placed upon summative functions. This is further reinforced by the fact that the minimum number of assessments required of trainees seems to be increasing almost annually. From my own experience, and supported by the literature, it is clear that WBAs are viewed
by many trainees as simply ‘tick-box’ exercises that must be completed to progress in their career, and as such are not valued.1,2 This impacts significantly upon the educational opportunities afforded by the tools, as this commonly leads to their misuse. For example, it is not uncommon around the time of annual reviews of competence progression (ARCP) to hear colleagues asking seniors if they can e–mail a ‘directly observed procedural skills’ (DOPS) assessment or ‘case-based assessment’ (CbD) for a procedure or case that they may or may not have witnessed the trainee complete at some point earlier in the year. The fundamental problem with this is that the trainee
then misses out on the discussion and formative case-specific feedback from a senior colleague: a valuable educational resource to any trainee doctor and, after all, the primary intention of WBAs. In recognition of these problems, the GMC has recently suggested a change in terminology: a move away from simply WBA, suggesting that ‘supervised learning events’ (SLEs), the main purpose of which are formative, should be distinguished from ‘assessments of performance’ (AOPs), which have a summative function. They propose that by highlighting the formative nature of SLEs, trainees would engage with the learning opportunity afforded them.
68 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 68–69
tct_12085.indd 68
1/2/2014 11:09:23 AM
Personally, I question what impact simply changing the name of WBAs will have. From my own experience and discussions with trainee colleagues, I think that much of the problem lies with a lack of understanding possessed by both trainees and trainers as to the educational value and purpose of WBAs. Many of my trainee colleagues do not see WBAs as being for their benefit, and even see them as interfering with their training and professional development. This is a problem that requires a change in mindset to solve.
I wonder if this is because of a lack of training. I cannot recall a time that it has been explained to me that the purpose of WBAs is to aid my development as a trainee, but I vividly remember being told I must complete the minimum number to progress. The summative functions are emphasised at the expense of the formative. To ensure greater engagement of trainees and trainers with WBAs requires them to be educated, but also requires training programme leads and deaneries to move away from emphasising just the summative functions. Perhaps this training
should start at medical school so that doctors enter the workplace informed and enthusiastic to engage with WBAs in the way intended. REFERENCES 1.
Bindal T, Wall D, Goodyear HM. Trainee doctors views on workplacebased assessments: Are they just a tick box exercise? Med Teach 2011;33:919–927.
2.
Pereira EAC, Dean BJF. British surgeons’ experiences of mandatory online workplace-based assessment. JRSM 2009;102:287–293.
The summative functions [of WBAs] are emphasised at the expense of the formative
Corresponding author’s contact details: Mr Jason M Ali, Box 202, Addenbrookes Hospital, Hills Road, Cambridge, CB2 0QQ, UK. E-mail: [email protected]
Funding: None. Conflict of interest: None. Ethical approval: Not applicable. doi: 10.1111/tct.12085
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 68–69 69
tct_12085.indd 69
1/2/2014 11:09:26 AM
