Conducting workplace based assessments

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Conducting workplace based assessments

• Philip DaCosta
• Consultant Histopathologist
• Member, RCPath WBA Working Group

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Outline

• Motivating trainers and trainees
• Organising the assessment process
• Conducting an assessment
• Providing feedback
• Workplace-based assessment as a formative process

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Its not all alien

• Build on existing structures
• Day-to-day clinical work/encounters
• Supervisory staff (medical, scientific and BMS)
• Use existing opportunities to train and assess
• WBA formalises existing supervision and improves
  feedback

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Motivation

• Clarity
• about process and method of assessment
• about number of assessments
• about trainees role
• about the assessors role
• about documentation and evidence
• Expectation
• monitoring arrangements
• linkage to the ARCP
• broad coverage of professional activities

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Organisation

• Cohort of assessors (appropriate to the relevant
  tasks)
• Training and familiarity with assessment tools
• Pacing of assessment process
• planner for year
• linkage to other processes (portfolio reviews,
  ESR, ARCP)
• remedial processes

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The mechanics
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Mini-PAT
CBD
Action
DOES
ECE
Mini-CEX
Performance
SHOWS
DOPS
Competence
KNOWS HOW
Knowledge
KNOWS
Millers pyramid of clinical competence
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Consider the focus of the assessment
CbD
Real time - HOW people do their work
Reflective - WHY they did what they did
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CbD
Reflective - WHY they did what they did
Real time - HOW people do their work
Multi-source feedback - global and team-based
assessment
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Number of WBAs during training
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Undertaking assessments
Opportunities and scenarios
Assessment process
Feedback
Guidance notes for assessors and
trainees Curriculum Schedules of scenario
complexity
Assessment form feedback guidance Personal
Development Plan Portfolio
Assessment form Standards for Assessment
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Overview of WBA document

• Customised for each specialty
• Similar content
• Introduction to WBA
• Outline of WBA tools
• Who can be an assessor?
• Standards for assessment
• Record keeping
• Examples of scenarios
• Hyperlinks to relevant guidance notes and forms

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Guidance note for each WBA tool

• Aimed at assessors and trainees
• Customised for each specialty and each tool
• Content
• Explanation of the WBA tool
• Suitable cases
• Who can be an assessor
• How the assessment works
• Standards for assessment
• Outcome of assessment
• Feedback
• Record keeping

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Opportunities scenarios
Opportunities and scenarios
Assessment process
Feedback
Guidance notes for assessors and
trainees Curriculum Schedules of scenario
complexity
Assessment form feedback guidance Personal
Development Plan Portfolio
Assessment form Standards for Assessment
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Opportunities - examples of DOPS

• Direct observation of practical skills (DOPS) -
  Chem Path
• use of pipette
• use of balance
• preparation of buffer
• measurement of glucose using meter
• urinalysis using dipstick
• use of blood gas machine
• manual (specify), e.g. osmometry
• use of bilirubinometer
• performance of sweat test
• insertion of long line
• supervision of dynamic function tests

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Opportunities - examples of DOPS

• Direct observation of practical skills (DOPS) -
  Histopathology
• Specimen cut up (e.g. a cancer resection, a group
  of skin biopsies)
• Autopsy procedures (e.g. initial evisceration,
  dissection of heart or other system, taking
  samples for toxicology)
• Set up and use of microscope
• Use of camera and specimen photography
• Handling and reporting of frozen section
• Systematic microscopic assessment of
  biopsy/cytology specimen
• Practical reporting procedures (e.g. completion
  of proformas, notification of case for MDT
  discussion, diagnostic coding, ensuring copies
  are sent to relevant individuals)
• Taking a fine needle aspirate

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Opportunities - examples of DOPS

• Direct observation of practical skills (DOPS) -
  Microbiology
• sample handling and preparation (including safe
  laboratory practice)
• safe disposal
• microscopy and staining
• identification presumptive or definitive
• use of selective media
• ability to distinguish between significant and
  non-significant pathogens and normal commensal
  flora
• ability to spot and separate mixtures of
  organisms, obtaining pure culture
• antimicrobial sensitivity testing setting up,
  reading and interpretation
• practical aspects of therapeutic drug monitoring
• serology
• molecular methodologies

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Opportunities - examples of ECE

• Evaluation of clinical/management events (ECE) -
  Chem Path
• Presenting audit findings and leading discussion
  on the action required
• Observation of a trainee led teaching event
• Demonstration and presentation of cases at MDT
• Presentation at grand round
• Referring a case for a specialist opinion
• Providing clinical biochemistry advice in
  response to enquiry (primary and secondary care)
  by letter, by phone
• Use of critical incident/non-conformity reporting
  procedures
• Presenting findings and leading discussion on the
  action required
• Preparing a business case
• Writing clinical guidelines
• Appointment of staff

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Opportunities - examples of ECE

• Evaluation of clinical/management events (ECE) -
  Histopathology
• evaluating and reporting a histopathology or
  cytology case
• evaluating and presenting autopsy findings to a
  clinical supervisor
• demonstrating autopsy findings to clinical team
• presenting cases in a MDT meeting/clinicopathologi
  cal conference
• presenting cases at a morbidity/mortality meeting
  or grand round
• referring a case for specialist opinion
• providing clinicopathological advice in response
  to an enquiry
• use of the call/recall and failsafe systems in
  cervical cytology screening
• use of critical incident reporting procedures
• handling a patient safety issue (e.g. specimen
  misidentification)
• presenting audit findings and leading discussion
  on the action required.

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Opportunities - examples of CbD

• Case-based discussion (CbD)
• Discussion of a case relating to specific areas
  of clinical practice
• eg. lipidology or nutrition on chemical pathology
• eg. blood stream inections or serological
  diagnosis in microbiology
• eg. complex case requiring immunohistochemistry
  in histopathology
• Involvement in critical incident or patient
  safety event
• Case involving diverging diagnostic opinions
• Case raising health and safety/risk management
  issues
• Evaluation of QC/QA data

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How to use opportunities for workplace-based
assessment

• Numerous opportunities/scenarios available -
  refer to guidance notes
• Be realistic about assessment
• duration
• complexity
• appropriateness
• Sampling

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Undertaking assessments
Opportunities and scenarios
Assessment process
Feedback
Guidance notes for assessors and
trainees Curriculum Schedules of scenario
complexity
Assessment form feedback guidance Personal
Development Plan Portfolio
Assessment form Standards for Assessment
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Conducting the assessment

• Ensure both you and the trainee have read and
  understood the guidance
• Check appropriateness of event
• Adequate time to undertake assessment and provide
  feedback
• Appropriate place for feedback
• Have the assessment form with you and make notes
  on it

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The assessment form
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Information about the assessment
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The assessment
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Feedback and outcome
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Outcome - satisfactory / unsatisfactory
A global judgement required to comply with
Gold Guide and ARCP requirements. In essence,
does the trainee need to repeat the assessment
SATISFACTORY
UNSATISFACTORY
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Personal calibration

• The experienced trainer
• All assessors will know what constitutes
  acceptable (ie. safe) clinical care/standards
• Assessors bring their experience to the
  assessment
• Refer to documentation
• Standards for assessment tools
• Curriculum
• Suggested complexity of scenarios at different
  stages of training
• Consistency within cohort of trainees
• educational supervisors will receive assessment
  forms from other assessors and will undertake
  assessments on a range of trainees

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Standards for assessment

• Trainees must be assessed against the standard
  expected of a trainee at the end of the stage of
  training that they are in
• The form offers a grading scale from 16
• 12 Below expectations
• 3 Borderline
• 4 Meets expectations
• 56 Above expectations
• Standards for assessment tools provides
  definitions and grade descriptors

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Process Standardisation

• Triangulation
• Checklist -v- Global rating
• Discussion amongst assessors
• College monitoring and QA processes

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Benefits of using the assessment form

• Gives structure to the encounter
• Encourages a systematic approach
• Generic forms, so some items will be not
  applicable (unable to comment)
• Reduces bias
• Helpful in providing feedback
• Helpful in identifying developmental points
• Helpful in commenting on behaviour

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Feedback
Opportunities and scenarios
Assessment process
Feedback
Guidance notes for assessors and
trainees Curriculum Schedules of scenario
complexity
Assessment form feedback guidance Personal
Development Plan Portfolio
Assessment form Standards for Assessment
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Providing feedback

• Immediate!
• Part of assessment process
• Consider using modified Pendleton framework
• what trainee felt went well
• what assessor observed went well
• what trainee would do differently in future
• developmental suggestions from assessor
• Focus on what was done and observed
• Use the form as part of the feedback process

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Using the assessments as a formative process

• What they know
• How they do things .
• How they present themselves
• How they learn
• How they are progressing
• Enthuse them .

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Focus on good feedback

• Trainees consistently report that senior review
  has major educational impact (as well as
  optimising patient care)
• The educational impact depends on good feedback
• Using structured feedback can encourage self
  appraisal, confidence and planned learning by the
  trainee

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Paperwork

• College intend to implement a web-based system
  from August 2008
• For now, use the paper based systems
• 3 (4) copies of assessment form (whether
  successful or unsuccessful)
• one into trainees portfolio
• one to educational supervisor
• one to RCPath assessment office (part of the WBA
  standardisation and validation process)
• (one copy to assessor, if they ask for it.
  Sensible to do this if assessment outcome is
  unsatisfactory)
• Educational supervisor can use information from
  all assessments in drawing up their report for
  the ARCP process, even though the trainee will
  only present successful WBAs as evidence to the
  ARCP panel

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Summary

• Understand the assessment tools and process
• Use your existing people, places and
  opportunities
• Train the trainers/assessors and trainees
• Allay their anxieties
• Use it as a formative process