Workplace-based Assessment (WBA) – Beyond the numbers

James KwanAssociate Professor, Emergency Medicine and Medical Education

Acknowledgements

• A/Prof Lukas Kairitis• Dr Karuna Keat• Professor Jenny Reath• Professor Wendy Hu• Members Year 3/5 Committee

Outline

• Competence vs. Performance• Overview WBA at UWS• Assessor judgements on performance• Delivering Feedback

Definitions• Competence

– “Ability to do something successfully” (Oxford Dictionaries, 2012)

• Competence in medicine– Ability to perform a specific clinical task– Requires integration of competencies– Measurable in terms of observable behaviour– Context specific– Process of growth and development

Knows

Shows how

Knows how

Does

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StandardisedAssessment(mostly established)

Non- standardised assessment(emerging)

Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S7.

Miller’s pyramid

Goals of WBA

• Make a judgement on a student’s performance of a specific task in the clinical setting

• Provide guidance to the student through effective feedback to improve future performance of the task

Examples

• Encounter based– Case Discussion (Long case in the workplace)– Mini-CEX (direct observation clinical/procedural

skill)

• Global– Clinical Attachment Assessment– Multi-Source Feedback (360)– Shift Feedback Form

Year 3 Mini-CEX

• Student (or assessor) selects a patient • Student performs a focused clinical task e.g.

history taking, physical examination, performing a procedural skill, counseling a patient

• Assessor directly observes the encounter• Assessor rates the student’s performance in a

range of domains and provides feedback• No longer than 30 min including feedback

Year 3 Mini-CEX

Challenges• Competence is developmental vs. normative (not

satisfactory, borderline, satisfactory, good and excellent)

• Assessors do not read the back page – use their own internal rubric

• Reluctance to rate a student as “not satisfactory” – “Failure to fail”

• Feedback is often limited and not as helpful as it could be

• A “tick box” exercise resulting in students chasing a number

Crossley, J., Johnson, G., Booth, J., & Wade, W. (2011). Good questions, good answers: construct alignment improves the performance of workplace-based assessment scales. Med Educ, 45(6), 560-569.

Construct aligned scales

• Judgement on extent to which a supervisor would trust a trainee (or student) to perform a task independently

• Descriptors reflect the need for close or more distant supervision

• Different contexts will have a different way of construing “independence”

• Greater reliability with fewer assessments– 3 vs. 6 Mini-CEXs required to achieve a

Generalisability coefficient 0.7

Domains of assessment

Construct aligned Mini-CEX

Providing effective feedback

Effective Feedback

• Characteristics• Perceived need for change• Technique• Creating an action plan• Coaching

Delivering Feedback

• Enable learner reaction• Encourage self assessment• Provide an assessment of strengths and

weaknesses• Develop an action plan• Document the feedback

Year 5 Emergency Medicine

Shift Feedback Form

Summary

• Competence is developmental• Construct aligned scales may help align both

assessor judgements on performance and the development of competence by the student

• Delivering effective feedback is an important part of the assessment process to guide student learning– Action plan and coaching

Questions?

j.kwan@uws.edu.au