Workplace-based assessment

The WPBA should be seen as a developmental process, says the RCGP's Dr Jane Mamelok.

Application of a simple dressing: one of eight mandatory procedures which form part of the WPBA
Application of a simple dressing: one of eight mandatory procedures which form part of the WPBA

The workplace-based assessment (WPBA) is one of three components of the new MRCGP exam process.

It is defined as 'the evaluation of a doctor's progress in their performance over time, in those areas of professional practice best tested in the workplace'.

WPBA seeks to test what the doctor actually does in practice, with colleagues and patients, providing evidence in 'attitudinal' areas, such as teamwork, working with colleagues and professionalism.

It involves seven tools which the trainee uses to demonstrate their competence: a case-based discussion and multisource feedback, used in all training posts; a consultation observational tool and patient satisfaction questionnaire, both in primary care; and three tools used mainly in hospital posts, direct observation of procedural skills (DOPS), clinical evaluation exercise (mini-CEX) and clinical supervisor's report.

Development
WPBA is a formative process, designed to guide trainees. The assessments give feedback on their development from novice to expert, and identify learning needs as trainees progress through the programmes.

It is important to recognise that the assessments are evidence-gathering tools and it is not necessary to pass each one but to identify developmental needs, build on them and chart that progression.

Competence
A competency framework underpins WPBA. Those competencies are derived from the RCGP's curriculum domains and The GMC's Good Medical Practice.

Assessors make judgments of competency progression throughout the programme. In this context, competence is defined as 'competent for licensing and independent practice'.So a grading of 'needs further development' is not a negative judgment but allows formative feedback.

By the end of the programme a trainee must have demonstrated a balanced portfolio of curriculum coverage and competency in 12 areas. Each tool can be used to demonstrate the 12 competencies.

The Annual Review of Competency Progression panels review evidence presented in the portfolio and judge competence and eligibility for the Certificate of Completion of Training.

ePortfolio
WPBA requires trainees to keep a training record and learning log, housed in the ePortfolio.

Trainees use their ePortfolio to track their training and map their learning experiences to curriculum and competency areas.

The educational supervisor reviews this log, assesses and agrees competency coverage and this validation is recorded in the ePortfolio and a picture of the learning journey builds up. The more evidence is presented, the clearer that picture and the sounder the final judgment.

How to succeed
Good planning is vital to success. The suggested schedule of assessments defines the minimum evidence required for each staged review and that informs the judgment of competency progression. It is important to discuss learning needs with the educational supervisor early on. Be aware of the assessments needed and schedule them.

Review progress regularly - it is far more difficult to cram assessments into the last few weeks of posts. Planning one a month is more realistic and gives greater opportunity for development.

Planning for DOPS is very important. Many of the procedures are best reviewed during secondary care placements and this avoids the stress of catching up in primary care.

There are eight required DOPS for WPBA but evidence from optional DOPS can be used to develop the professional portfolio.

Use the assessments formatively. A case-based discussion done early in ST1 is unlikely to show competence or excellence in the desired competencies but it gives a snapshot of performance at that stage. Assessors can give feedback on how to improve.

Look for the learning opportunities. The contextual nature of WPBA provides rich learning opportunities; keeping a reflective diary helps capture that information and the competencies it tests can be reviewed and validated by the trainer during professional conversations. It is important to be selective in the learning log entries - record personal reflections not documents and handouts.

The RCGP website is a useful resource and can offer practical advice on the tools and documentation for both trainees and assessors. It is regularly updated and is the preferred vehicle for informing about important developments in the assessment process.

Curriculum
The new RCGP curriculum provides a unique opportunity to promote self-directed learning, tailored to individual needs. The curriculum instructs educators what to teach and informs trainees about what the outcome of that learning should be.

The purpose of the WPBA is to gather evidence of a GP's competence and capture it in the training record and ePortfolio. Being a GP and achieving excellence is a lifelong journey of professional development, and WPBA is only the first stage of that journey.

Dr Mamelok is a GP partner in Cheadle, Greater Manchester, and a GP trainer, MRCGP examiner and the RCGP WPBA clinical lead

Getting the most from WPBA

1. The WPBA is a formative process, involving several tools, carried out throughout the three years of training.

2. Schedule assessments with plenty of time to review progress in between.

3. Plan time for the eight mandatory DOPS and consider which to do in secondary care.

4. Keep the ePortfolio up to date and gather maximum evidence from a variety of sources.

Resources

  • Bloom B S et al. Taxonomy of Educational Objectives: Handbook 1 Cognitive Domain New York: D McKay, 1956.
  • Riley B, Haynes J, Field S. The Condensed Curriculum Guide. London: The Royal College of General Practitioners, 2007.

The RCGP
The Royal College of General Practitioners is a network of over 35,000 family doctors. They work to encourage and maintain the highest educational, training and clinical standards in order to improve care for our patients.

 

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