Why workplace-based assessment?
The educational argument for integrating teaching, learning and assessment is powerful. We know that assessment drives learning and it is therefore imperative that workplace-based assessment focuses on important attributes rather than what is easiest to assess. Complex professional attributes are difficult to assess using standardised assessment methods such as written exams or OSCEs. These are better assessed in workplace situations.
We know that learning is at its most powerful when it is ‘authentic’. This means when the learning is integrally related to the understanding and solution of real-life problems (Kaufmann et al., 2000). We also know that assessment is more valid the closer we get to what we wish to assess. Authenticity is particularly important when it comes to assessing doctors because of the problem of case specificity. Therefore observing doctors in real-life situations becomes more important, allowing the collation of multiple snap shots of performance to give a global and holistic perspective of the learner.
The Postgraduate Medical Education and Training Body (PMETB) has the responsibility for overseeing specialist training and recognises the importance of reassuring the public about the safety and competence of its doctors. It has recommended in its principles of assessment that workplace-based assessments form an important part of the assessment framework (PMETB, 2003).
Workplace-based assessments cannot replace standardised assessments yet. There are problems with reliability as a result of inconsistent application of tools across different raters or assessors. There is potential conflict in the role of an educational supervisor who is supervising the learner, but is also involved in the assessment process. There are also problems of attribution to an individual, as opposed to the clinical team, when routinely collected clinical practice data are assessed.
So what issues are important to consider in designing a programme of workplace-based assessment?