MRCGP - Workplace-based assessment guide

Dr Osman Bhatti outlines the best approach for trainers to take when conducting WPBA sessions.

The workplace-based assessment (WPBA) looks at the performance of a doctor in the workplace and is recorded in the ePortfolio. It forms a part of the evaulation of a trainee GP's progress over time and prepares the trainee for independent practice.

Ideally, it should be used to provide feedback to the trainee and highlight areas that need to be addressed.

The educational supervisor should review the WPBA at regular intervals with the trainee.

There are seven tools used in the WPBA:

  • Multi-source feedback (MSF)
  • Patient satisfaction questionnaire (PSQ) - primary care
  • Consultation observation tool (COT) - primary care
  • Case-based discussions (CBD)
  • Direct observation of procedural skills (DOPS) - secondary care
  • Clinical evaluation exercise (Mini-CEX) - secondary care
  • Clinical supervisor's report (CSR) - secondary care

For each tool there is a minimum number that must be completed, but the trainee should aim to do more than the minimum.

The Annual Review of Competency Progress panel review and assess the submitted documentation and evidence. If all the competencies have been demonstrated, the trainee will be recommended for completion of training.

The main bulk of the WPBA is made up of CBDs and COTs which will be discussed further.

TOOLS TO ASSESS WPBA COMPETENCIES
Competence areaMSFPSQCOTCBDCEXCSR
Communication and consultation skills
Practising holistically
Data gathering and interpretation
Making a diagnosis/decisions
Clinical management
Managing medical complexity
Primary care admin and information technology
Working with colleagues and in teams
Community orientation 
Maintaining performance, learning and teaching
Maintaining an ethical approach 
Fitness to practise 

Case-based discussion
The minimum requirements for CBDs are six in each year for ST1 and ST2, and 12 for ST3.

The trainee will select cases (usually two cases for ST1/2 and four in ST3) and present the clinical entries and relevant records of each case to the clinical or educational supervisor one week before the discussion takes place.

The supervisor, having chosen one or two of these cases, forms a discussion based on the case. As a supervisor, use your questions to elicit evidence of competence and not to test the knowledge base of the case.

The supervisor should aim to cover as many competencies as are relevant to each case in the time allocated.

The evidence gathered is then entered onto the ePortfolio by the supervisor against the appropriate competence areas.

It should take a total of about 30 minutes to cover the discussion, complete the rating and provide feedback to the GP trainee.

Consultation observation
The COT is based on either a video-recorded consultation or a directly observed consultation by the trainer which leads onto a discussion. Evidence is recorded in the ePortfolio and feedback provided to the trainee.

Consultations that go into more depth or are more complex in nature will generate more evidence that can be evaluated.

Although a COT can be done easily by the trainer directly observing a consultation, there is probably more to discuss and evaluate by using a video consultation.

For the directly observed consultation, a prospective patient encounter is chosen and is directly observed by the trainer who then rates the consultation against the competency framework and COT criteria. For the video-recorded consultation, the trainee will record a number of consultations and one is selected for discussion and assessment.

In either case, it is imperative that patient consent is obtained before and after each consultation. The reception staff can assist in obtaining patient consent when the patient books in and then after the consultation before leaving the practice.

The consultations assessed should be broad and differ in context. They should include a child under 10, an adult over 75 and a case based around a mental health issue.

As was the case with previously assessed consultation video assessments, this is not to be used as a pass/fail issue but for personal development and should help to develop the competencies. The consultations should generally not be longer than 15 minutes in duration.

The COT is one of the most useful tools in the WPBA and the feedback, as well as the recommendations for the trainee to improve and develop their consultation skills further, can often be a very useful exercise.

  • Dr Bhatti is a GP and a programme director on Newham VTS, east London
  • This topic falls under section 3.7 of the RCGP curriculum, Teaching, Mentoring and Clinical Supervision', www.healthcarerepublic.com

Learning points

1. The WPBA is carried out over the three years of GP training.

2. Regular reviews should take place and the evidence gathered should be recorded on the ePortfolio.

3. Questions in CBDs, should aim to elicit the trainee's competence in that area.

4. Ensure patient consent is obtained for observed consultations.

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