Conducting workplace based assessments Philip DaCosta Consultant Histopathologist Member, RCPath WBA Working Group

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

“It’s 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

Motivation Clarity about process and method of assessment about number of assessments about trainee’s role about the assessor’s role about documentation and evidence Expectation monitoring arrangements linkage to the ARCP broad coverage of professional activities

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

The mechanics…

KNOWS KNOWS HOW SHOWS DOES Miller’s pyramid of clinical competence Knowledge Competence Performance Action CBD ECE Mini-CEX DOPS Mini-PAT

DOPSECE Mini- CEX CbD Real time - HOW people do their workReflective - WHY they did what they did Consider the focus of the assessment

DOPSECE Mini- CEX CbD Real time - HOW people do their work Reflective - WHY they did what they did Multi-source feedback - global and team-based assessment

ePATH- SPRAT (MSF) Direct Observation of Practical Skills (DOPS) Case- based Discussion (CbD) Evaluation of Clinical Events (ECE) Mini- Clinical Evaluation Exercise (Mini-CEX) Chemical Pathology 3 during training Minimum 6 per year for first 2 years Minimum 6 per year Histopathology3 during training Minimum 6 per year up to end of stage C Minimum 6 per year - Medical Microbiology & Virology 3 during training Minimum 6 per year -- Number of WBAs during training

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

“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

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

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

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

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 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 Opportunities - examples of DOPS

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 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/clinicopathological 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.

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

How to use opportunities for workplace-based assessment Numerous opportunities/scenarios available - refer to guidance notes Be realistic about assessment duration complexity appropriateness Sampling

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

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

The assessment form

Information about the assessment …

The assessment …

Feedback and outcome …

Outcome - satisfactory / unsatisfactory … SATISFACTORY UNSATISFACTORY A “global” judgement required to comply with “Gold Guide” and ARCP requirements. In essence, does the trainee need to repeat the assessment…

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

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 1–6: 1–2 Below expectations 3 Borderline 4 Meets expectations 5–6 Above expectations “Standards for assessment tools” provides definitions and grade descriptors

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

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

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

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

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 ….

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

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 trainee’s 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

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