Workplace-Based Assessments
You may find the series of videos on assessments in the online induction section helpful.
Workplace-based assessments (WPBAs) are used in internal medical training to assess a trainee's performace in the workplace. They aren't necessarily a test of knowledge but more an assessment of skills, behaviours, attitude and actual performance. As well as being an assessment of learning (working out where a trainee is now), they can have a significant role in helping trainees develop and so can also be viewed as an assessment for learning.
There are multiple different types of WPBA used in IMT and these are described below. Minimum numbers of each type are set out in the JRCPTB decision aid and it's important to note that these need to be completed by a consultant. It is recommended however that trainees go above and beyond this minimum number and that these can be done by various other people such as StRs and specialist nurses and that these may still be used for curriculum sign off. It is not however appropriate to have these done by other core trainees.
Like every other area of your portfolio, it's expected that your WPBAs will be spread throughout the year and not just clustered around your ARCP.
It is best to fill in the form immediately with your assessor. The assessment part of the form can then be completed under your own log-in. You can fill in what case was discussed and what aspects are being assessed e.g. history, time management, chest pain etc and then ask your assessor to complete the assessment and, most importantly, give you feedback on your performance. This ‘instantaneous’ feedback is the most valuable. If the assessor writes a bland comment such as ‘did well’ ask him/her if they could identify something you did well and something you could improve. You should aim to use the ‘Request external assessment’ ticketing facility sparingly. Using the ‘request’ ticketing system means that the form submission may be delayed as assessors may forget to do it for you.
You must ensure you do enough SLEs – there are minimum requirements for each year in IMT (check your 'ARCP decision aid'). The SLEs must be spread over the whole training year, obtaining 10 consultant WPBAs in the month before the ARCP is not acceptable.
The multi-source feedback assesses generic skills such as communication, teamwork and leadership. The trainee chooses 'raters' and sends out ticket requests. It is generally recommended that more tickets need sending out than then minimum requirement as 100% completion rate is unusual. The number and breakdown of respondents required are defined in the ARCP decision aid. Importantly, note the minimum number of respondents from consultants and the requirement for the respondents to reflect a spread of professionals and for the period covered to be relatively short. Once an adequate number of responses have been collated your educational supervisor can release them too you. The trainee will not usually see the individual responses, just the collated report.
Different regions have different requirements regarding MSF timings and you'll be informed of this by your TPDs.
If there are training concerns you may be asked to complete a second MSF at another time as well but if this is the case the reasons will be clearly communicated to you.
The JRCPTB describe mini-CEX as: evaluating 'a clinical encounter with a patient to provide feedback on skills essential for good clinical care such as history taking, examination and clinical reasoning. The trainee receives immediate feedback to aid learning. It can be used at any time and in any setting when there is a trainee and patient interaction and an assessor is available.
They may be linked to curriculum competencies in the ePortfolio as evidence of engagement with, and exploration of, the curriculum. However, it is not appropriate for an SLE to be linked to large numbers of competencies and for this reason the number of links for mini-CEX should be limited to two competencies in the curriculum.'
They can cover areas including history, examination and clinical reasoning and it's expected that you will have them completed by a number of different assessors over the course of IMT. It is highly recommended to get them completed at the time of assessment in order to get the most benefit from them.
These are used in the assessment of practical skills. They should initially be formative (used more to provide feedback on the procedure) but sign off for procedures requiring independence needs to be summative and by two separate people (note these don't have to be consultants but do need to be skilled in the procedure themselves and not other core trainees).
The JRCPTB IMT and GIM advisory committees have produced guidance on interpretation of DOPS sign off.
Over the last few years some trainees have had difficulty in performing certain procedures in certain hospitals and steps have been taken to rectify this situation but any trainee having difficulty is advised to get in contact with their TPD earlier rather than later.
These assess clinical reasoning and decision-making and shouldn't just be a discussion of an 'interesting' case. They look at the application of knowledge and as well as filling gaps in the curriculum are a very useful tool for learning and it's highly recommended that the assessment ticket is completed by the assessor with the trainee present at the time of assessment. You can prepare for this in advance by sending your supervisor some brief notes on the case, or bringing along brief notes for discussion.
The ACAT may be new to many of you but is something that continues throughout physician training after IMT. Whereas the mini-CEX and CBD assess more directly your assessment and patient management skills of individual cases, these look more broadly at your acute care work. As well as including clinical assessment and decision making they should reflect your skills in medical record keeping, investigations and referrals, time management, prioritisation, team working, communication, clinical leadership and handover.
It requires a minimum of five patients to be included and should be completed by a consultant. It's important to note that all five patients don't necessarily have to be seen with that individual consultant but they should be aware of the details of all five and it's perfectly acceptable for a consultant to discuss with their consultant colleagues and registrar overing the period regarding your management of cases they didn't see directly.
Different hospitals have different opportunities to complete these which are often on call days and night shifts. We highly recommended talking to your supervisors or other trainees in the hospital you're in to find out the best way to do them there. It's generally felt that trainees who are proactive and ask a consultant at the start of a shift if they could "complete and ACAT on the patients they see on that take" find it easier to get them completed.
It's important to start thinking about an area of quality improvement you would like to work on when you start each year. Please speak to the departments you rotate into, as well as other trainees, for projects they require to be done - they are likely to be extremely welcome of the help. During the IMT3 year, you are expected to demonstrate leadership in your QI activity therefore starting the process early on will ensure you have adequate time.
Following the completion of any quality improvement project you should ask your supervisor to complete a QIPAT for you.