A BEME (Best Evidence in Medical Education) review of the use of workplace-based assessment in identifying and remediating underperformance among postgraduate medical trainees: BEME Guide No. 43

Abstract

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).

Utility of selection methods for specialist medical training: A BEME (best evidence medical education) systematic review: BEME guide no. 45

“…There was a sense that selection frameworks have been developed in isolation to other important and related curricular concepts within medical education and training such as assessment. While there were some linkages in selection frameworks to the tenets of competency-based medical education (CBME), there was little linkage with the advances in assessment of trainees such as developments in work-based assessment (Barrett et al 2016). Of those studies that did express a statement about underpinning concepts, most were limited to reflecting upon the need to consider both personal academic (or cognitive) and nonacademic (non-cognitive) capabilities (Patterson et al 2008;Patterson, Tavabie, et al 2013).…”

“Conversational Advice”: A mixed-methods analysis of medical residents’ experiences co-managing primary care patients with behavioral health providers

“…Feedback can be a challenge to coordinate for physician preceptors with various competing priorities of teaching in the midst of clinical care [25]. Furthermore, accurate evaluation of residents' skills may require evaluations from many independent clinical observations [26,27]. Medical educators agree that appropriate and timely feedback is often not given to learners, but is essential to developing skills and professionalism [28,29].…”

Workplace‐based assessments in postgraduate medical education: A hermeneutic review

“…33,42,45 The dominant theme around WBAs' purpose was the tension between formative and summative purposes. 3,9,13,23,27,[30][31][32]36,41,42,44,45 Trainees and assessors viewed 'formative' and 'summative' as mutually exclusive categories, arguing that summative WBAs create '… a conflict of interest between creating a learning experience for the trainee and the need to document competence ….' 32 The shift from formative to summative WBAs causes trainees to shift their focus from learning to performance, resulting in WBAs' authenticity being undermined by trainee stress and gaming, 9,30,31,33,42 and lower engagement with the feedback.…”

“…13,23,[36][37][38]43,51 Yet this confusion may stem from research limitations, notably an absence of theoretical frameworks, limited study designs (eg, lack of pre-post analyses and triangulation), and evidencing learning through performance changes, a metric that does not capture affirmation of good practice. 44…”

“…3,27,40,41,45 Additionally, the assessor's level of self-reflexivity may enhance their observational capacity, 50 whereas assessors believe junior trainees are more engaged and receptive to feedback than senior trainees. 42 The definitions, frameworks and scales in the tool can guide assessors' observations and, in turn, decision making, 13,23,29,30,38,42,44,45,48,52 whereas training organisation policies such as requirements regarding minimum quantities or frequencies of WBAs may stimulate inactive trainers and trainees. 41 Perhaps the most potent determinants are how these factors interact.…”