Education and Training

New workplace based assessments for Specialty Registrars in Occupational Medicine

What are workplace-based assessments? What is their purpose?

So-called 'workplace-based assessments' (WBAs) are an important component of the higher specialist training programme in occupational medicine. They are integral to the curriculum and assessment framework approved by the statutory regulator, the PMETB, and their delivery is a requirement of training post approval.

Traditionally, the assessment of trainees in medicine has given most emphasis to written examinations – tests of what a person knows, rather than what they actually do in real practice. Educational supervisors have also signed up trainees as ‘competent’ in their work, but by relatively informal subjective processes with limited evidence collected to support judgments; and the content of on-the-job training and on-the-job experience has been arrived at in a relatively informal way.

WBAs are on-the-job assessments of day-to-day performance. Informally, trainers have already been conducting them. For example, most supervisors will have sat in on some of their trainees’ consultations, discussed problem cases with them, checked over a sample of their correspondence, made sure they can perform everyday clinical procedures correctly, and helped them plan a portfolio, recording a set of learning experiences and objectives. These are WBAs. The old curriculum encouraged such activities; the new arrangements formalise this, ensuring a more systematic approach to their conduct, recording and end use.

Formal on-the-job assessments are useful in many ways. They have an important formative function, helping the trainee to: chart their progress (areas of strength and developmental needs), document the acquisition of competencies, receive regular feedback from experienced senior colleagues, and plan their educational objectives. More generally, they assist reflection and development – assessment is often the bolt on extra at the end, but regular constructive feedback should be an integral part of educational planning; they support and underpin the quality assurance of training, by confirming that developmental expectations are being met; and they drive learning. Naturally, trainees put most effort into those things that are examined – WBAs ensure that this effort is directed at everyday performance rather than abstract knowledge.

Finally, WBAs are the main vehicle for assessing certain important competencies that are hard to measure in other ways (e.g. professional behaviour, probity, team working); and for identifying trainees in difficulty who need special support. Ultimately they are needed to reassure the public that by the end of their training, the doctor is a rounded specialist, fit for purpose.

“The emphasis is moving rapidly away from gaining a certain number of marks in high-stakes examinations and more towards gathering evidence of clinical competence and appropriate professional behaviour and attitudes. Much of this evidence cannot be captured in the kind of formal examinations that have traditionally been the primary focus in postgraduate training. It is demonstrated, day in, day out, in the workplace and seen by educational supervisors, other team members, fellow healthcare workers, patients and their relatives and carers. Since it is both demonstrated and observed in the workplace, then it stands to reason that the workplace is where the evidence can be gathered.”
PMETB (2005)1