Profiling postgraduate workplace-based assessment implementation in Ireland: a retrospective cohort study

Abstract

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.

Direct Observation of Procedural Skills in Otorhinolaryngology Training

“…Based on this result, DOPS can be suggested to be implemented more frequently in the first years of residency training. Similar suggestions are also found in the literature (6,11). Looking at this data we can say that all residents in our clinical department reach a satisfactory level of competency in DOPS-procedural skills.…”

“…In fact, both the trainees and the trainers have indicated the difficulty of finding the time to exercise DOPS, given their intense workload. A study conducted in Ireland reports that this section was left blank in up to 25% of the rating forms (6). According to our experiences in this study, verbal feedback is faster since it is a face-to-face process applied on the spot.…”

“…That the process aims at determining the level of the trainee and giving feedback, rather than a pass/ fail decision, is the major factor in why DOPS was embraced by the trainees. Studies strongly recommend that DOPS and other workplace-based assessment tools are not used for the purposes of pass/fail rating (6,18,19).…”

“…DOPS was first designed by the members of the Royal College of Physicians in the United Kingdom (3). In the broadest sense, DOPS is an assessment tool that can be used in the overall assessment of diverse procedural skills at different difficulty levels from vascular access establishment to endotracheal intubation, from nasogastric tube placement to arterial blood sampling (4)(5)(6).…”

“…DOPS is recommended to be used in formative assessment (4)(5)(6). Here, the purpose is not to make a pass/fail decision, but rather to identify how efficiently the trainee can perform the procedure, to specify any areas, if any, that need improvement and to enable the trainee to improve their perfor-mance by providing feedback.…”