Workplace-based assessment needs to be better resourced to improve the clinical standards of trainees and win the confidence of the profession, a new report claims.
The Academy of Medical Royal College’s report, called Improving Assessment, says that while knowledge-based testing continues to be well supported, workplace based testing isn’t.
Workplace-based training was introduced as part of Modernising Medical Careers in 2005. Previously clinical and practical skills were only assessed as a component of formal examinations. Workplace-based assessment (WPBA) was introduced because previous assessments of actual performance in the workplace were largely informal, often anecdotal and rarely documented.
But the report says: “Unrealistic timescales together with a lack of resources and inadequate assessor training led to the hurried implementation of WPBA and the development of undesirable practices.
“This has resulted in widespread cynicism about WPBA within the profession, which is now increasing…the profession is rightly suspicious of the use of reductive ‘tick-boxing’ approaches to assess the complexities of professional behaviour, and widespread confusion exists regarding the standards, methods and goals of individual assessment methods.”
The report suggests that the purpose of the assessment method and the system needs to be clearly defined and communicated to all participants. It was introduced to help trainees identify areas for improvement and is thus formative not summative.
The collapse of the online recruitment system MTAS led to concern and confusion about the use of WPBA for ranking and selection purposes. It must not be used to rank trainees for selection to specialty, says the report.
It also calls for the role of supervisors to be clarified and defined and all assessors to be trained in order to improve the standards. Employers are also called on to recognise the contribution supervisors and assessors make to the future workforce – particularly through job planning.
“A change in thinking is needed,” says the report. “There must be a move away from the increasingly mechanistic approach that is currently being promoted, and a move back to the basic educational principles that have served well previously.
“Assessment is inseparable from learning, and at the heart of it is the relationship between the educational supervisor and the trainee. It is this relationship that must be fostered and encouraged. The primary purpose of WPBA must be to promote learning and inform this relationship.”
A spokesperson for the Postgraduate Medical Education and Training Board said: “PMETB approves assessment systems (not individual tools) and we approve training against the published standards. As part of this, we have developed standards for trainers so that there are minimum, national standards for all trainers of all specialties. Colleges and deaneries have responsibilities in these and undertake a wide range of activities, the former particularly in relation to assessors and examiners.
“There is much good practice already and we will continue to work with stakeholders including those who commission training (and so drive the resources) to continue to improve conditions and quality of supervision. Our remit doesn’t extend to resourcing but we shall soon be publishing principles for commissioning. We will continue to work with colleges and deaneries to ensure our standards for assessment are met and exceeded.”
Read full report.