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What is workplace-based assessment?

Workplace-based assessment refers to the assessment of working practices based on what doctors actually do in the workplace, and is predominantly carried out in the workplace itself (PMETB, 2007).

Miller’s ‘pyramid of competence’ (Miller, 1990) is also useful for mapping assessment methods against the various tiers of the pyramid. The ‘knows’ level of the pyramid can be assessed using simple knowledge tests, e.g. multiple-choice questions (MCQs). The ‘knows how’ level can be assessed using unfolding patient management problems (PMPs) or essay questions. Objective Structured Clinical Examinations (OSCEs) can assess the ‘shows how’ level. The difficulty has always been assessing the ‘does’ level, which in professional practice refers to performance in context.

Miller’s pyramid

Model of competence

Competence versus performance

Competence indicates what people can do in a contextual vacuum, under perfect conditions. This might be evident using controlled assessment methods looking at the lower tiers of Miller’s pyramid. Performance, however, indicates how people behave in real life, on a day-to-day basis.

The problem is that what doctors do in controlled assessment situations correlates poorly with their actual performance in professional practice (Rethans et al., 2002). Therefore we need assessment methods that focus on the top end of the pyramid. This is where workplace-based assessment comes in.

In workplace-based assessment we are assessing performance in vivo using samples of data gathered  from the working practice of the doctor. The notion of adequate sampling is critically important and will be referred to later.

Thinking point

  • Are you using, or familiar with, any assessment methods that assess at the top level of Miller’s pyramid?


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