Doctors share with airline pilots, and others to whom the public entrust their lives, a requirement to develop complex skills over many years of supervised training, and to demonstrate their competence in performing routine tasks and managing crises. Psychiatry, with its focus on spoken communication, has tended to rely on in vitro methods of supervising training (cosy one-to-one supervision behind closed doors well away from patients or team colleagues, or case presentations in busy ward rounds) rather than the direct, in vivo transmission of skills expected of a classical apprenticeship.
For many reasons, helpfully summarised in the preface and introduction to Workplace-Based Assessments in Psychiatry, these methods have been found wanting and a range of unfamiliar methods of assessing trainees are being introduced. Bhugra, Malik & Brown aim to provide both a handbook and a practical manual for the new generation of assessors and the trainees they will guide. How well do they succeed in these overlapping, but distinct, aims?
The majority of the book comprises a set of monographs on the separate instruments that will be used to structure and record their assessments. These are supplemented by an appendix that allows both assessors and trainees to see, possibly for the first time, the forms used to do so. As a ‘how to’ manual this succeeds well, and the detailed performance descriptors will do much to demystify the process (and the plethora of acronyms: DOPS, mini-ACE, and the like). The major deficiency of this section, which could be remedied easily, is the lack of a timeline to show when and how the various techniques should be timetabled into busy clinicians' diaries.
Less satisfying are the handbook components that should provide rationale and context. Psychiatry has benefited from the fact that other specialties have been using similar methods for some time, so there is both experience and evaluation of their use. However, although the overview of methods is clearly written, it has too little evidence to draw upon and the section on pilot studies cannot provide assessors and trainees with confidence that the new system is more than ‘work in progress’ (p. 107). Tensions between the context-specific limitations of workplace-based assessments and the need for generalisability of psychiatric skills are touched on but in a chapter that focuses too heavily on a description of the possible structure of the new MRCPsych examinations. Finally, at no point is it clear that the whole is more than the sum of its parts: there is too little indication of whether the assessment tools are sufficiently joined-up and cover all aspects of specialist training. If the Postgraduate Medical Education and Training Board requires assessment to be ‘based on curricula’, where is the curriculum map to show how one relates to the other and highlight the gaps?
This book should be read by assessors and trainees for its ‘how-to’ procedural instructions. A second edition should follow soon to remedy its deficiencies and to ensure that this useful manual does not become obsolete as the tools it describes evolve. A second edition should also correct some sloppy usage, such as the interchangeable use of competence/s and competency/ies (the General Medical Council favours the former) that occur sometimes in a single paragraph.
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