WBAs provide trainees with a justified reason to approach trainers for feedback. WBAs, however, are not being reified as the formative assessments originally intended. A culture change may be required to change the focus of WBA research and reconceptualise this set of tools and methods as a workplace learning .

The extent to which WBA can be used to detect and manage underperformance in postgraduate trainees is unclear although evidence to date suggests that multirater assessments (i.e. MSF) may be of more use than single-rater judgments (e.g. mini-clinical evaluation exercise).

In 2010, workplace-based assessment (WBA) was formally integrated as a method of formative trainee assessment into 29 basic and higher specialist medical training (BST/HST) programmes in six postgraduate training bodies in Ireland. The aim of this study is to explore how WBA is being implemented and to examine if WBA is being used formatively as originally intended. A retrospective cohort study was conducted and approved by the institution’s Research Ethics Committee. A profile of WBA requirements was obtained from 29 training programme curricula. A data extraction tool was developed to extract anonymous data, including written feedback and timing of assessments, from Year 1 and 2 trainee ePortfolios in 2012–2013. Data were independently quality assessed and compared to the reference standard number of assessments mandated annually where relevant. All 29 training programmes mandated the inclusion of at least one case-based discussion (max = 5; range 1–5). All except two non-clinical programmes (93 %) required at least two mini-Clinical Evaluation Exercise assessments per year and Direct Observation of Procedural Skills assessments were mandated in 27 training programmes over the course of the programme. WBA data were extracted from 50 % of randomly selected BST ePortfolios in four programmes (n = 142) and 70 % of HST ePortfolios (n = 115) in 21 programmes registered for 2012–2013. Four programmes did not have an eligible trainee for that academic year. In total, 1142 WBAs were analysed. A total of 164 trainees (63.8 %) had completed at least one WBA. The average number of WBAs completed by HST trainees was 7.75 (SD 5.8; 95 % CI 6.5–8.9; range 1–34). BST trainees completed an average of 6.1 assessments (SD 9.3; 95 % CI 4.01–8.19; range 1–76). Feedback—of varied length and quality—was provided on 44.9 % of assessments. The majority of WBAs were completed in the second half of the year. There is significant heterogeneity with respect to the frequency and quality of feedback provided during WBAs. The completion of WBAs later in the year may limit available time for feedback, performance improvement and re-evaluation. This study sets the scene for further work to explore the value of formative assessment in postgraduate medical education.

Background: The Assisted Decision-Making (ADM) (Capacity) Act 2015 was enacted by Dáil Éireann in December 2015. The purpose of the act, as it applies to healthcare, is to promote the autonomy of persons in relation to their treatment choices, to enable them to be treated according to their will and preferences, and to provide healthcare professionals with important information about persons and their choices in relation to treatment. In practice, those patients with cognitive impairment, particularly dementia, and those with complex needs requiring composite decisions present the greatest challenge to healthcare professionals practicing in accordance with this legislation. Patients with complex needs requiring multifaceted decisions are often over 70 years of age and present in acute hospitals experiencing some form of cognitive impairment. Objectives: The aim of this project is to develop an educational tool which will promote understanding of ADM among healthcare professionals working in acute care settings, and encourage their adoption of this understanding into their care planning with older people. Research design: The study design for this project is mapped out over four consecutive work packages combining a multimethod approach including rapid realist review, qualitative exploration, participatory learning and action sets and intervention trialling and revision. This incremental and context sensitive approach to research design is appropriate for the exploration, development and evaluation of a complex behaviour change intervention. Conclusion: The targeted beneficiaries of this project are healthcare professionals working within acute care settings as well as older people and their family carers who are interacting with the acute care system. The potential impact is improved communication between healthcare professionals and their patients in relation to assisted decision-making and care planning. This educational intervention will be embedded into the pedagogic strategies of the RCPI in their postgraduate education curricula as well as the continuous professional development scheme.

BackgroundWorkplace-based assessments were designed to facilitate observation and structure feedback on the performance of trainees in real-time clinical settings and scenarios. Research in workplace-based assessments has primarily centred on understanding psychometric qualities and performance improvement impacts of trainees generally.An area that is far less understood is the use of workplace-based assessments for trainees who may not be performing at expected or desired standards, referred to within the literature as trainees ‘in difficulty’ or ‘underperforming’. In healthcare systems that increasingly depend on service provided by junior doctors, early detection (and remediation) of poor performance is essential. However, barriers to successful implementation of workplace-based assessments (WBAs) in this context include a misunderstanding of the use and purpose of these formative assessment tools.This review aims to explore the impact - or effectiveness - of workplace-based assessment on the identification of poor performance and to determine those conditions that support and enable detection, i.e. whether by routine or targeted use where poor performance is suspected. The review also aims to explore what effect (if any) the use of WBA may have on remediation or on changing clinical practice. The personal impact of the detection of poor performance on trainees and/or trainers may also be explored.Methods/designUsing BEME (Best Evidence in Medical Education) Collaboration review guidelines, nine databases will be searched for English-language records. Studies examining interventions for workplace-based assessment either routinely or in relation to poor performance will be included. Independent agreement (kappa .80) will be achieved using a randomly selected set of records prior to commencement of screening and data extraction using a BEME coding sheet modified as applicable (Buckley et al., Med Teach 31:282-98, 2009) as this has been used in previous WBA systematic reviews (Miller and Archer, BMJ doi:10.1136/bmj.c5064, 2010) allowing for more rigorous comparisons with the published literature. Educational outcomes will be evaluated using Kirkpatrick’s framework of educational outcomes using Barr’s adaptations (Barr et al., Evaluations of interprofessional education; a United Kingdom review of health and social care, 2000) for medical education research.DiscussionOur study will contribute to an ongoing international debate regarding the applicability of workplace-based assessments as a meaningful formative assessment approach within the context of postgraduate medical education.Systematic review registrationThe review has been registered by the BEME Collaboration www.bemecollaboration.org.