The future of workplace-based assessments for core trainees

We were pleased to read the two surveys of trainees' and trainers' experiences of workplace-based assessments (WPBAs) ^1,2 and the accompanying commentary ³ in which Femi Oyebode neatly put his finger on some of the difficulties and challenges that have accompanied the College's adoption of these training tools. Inadequate training of hard-pressed trainers, lack of clarity concerning the relative importance of formative and summative functions, and the increasing bureaucratisation involved in the collection of portfolio evidence have all obscured the potential usefulness of the assessments. We thought that it would be useful for us to report how the College is planning to help trainees and trainers with the WPBAs for core training in the light of our own concerns and those reflected in the journal.

Delivery of anything more than the most superficial training in WPBAs to all clinical and educational supervisors has proved challenging. Consultant trainers are overwhelmingly conscientious about their responsibilities in delivering supervision and completing assessments but have found it hard to access WPBA trainer training. We have asked each of the Faculty Education and Curriculum Committees to produce a series of new standardised WPBAs, each one based on an important curriculum competency, and to provide a single-page trainer's guide to that specific assessment that will tell the trainer exactly what should be covered and what is expected from their trainee to complete the assessment satisfactorily. These ‘set’ assessments, together with the relevant trainer's guides, will appear in a few months on Assessments Online (https://training.rcpsych.ac.uk) when trainers and trainees log on to complete an assessment. Our hope is that this will provide in-service training for assessors as well as a series of WPBAs whose content is consistently high and focused upon acquisition of the most important curriculum competencies. The Chief Examiner has offered to provide Clinical Assessment of Skills and Competences (CASC) examiner training to interested trainers - even if they are not necessarily intending to examine - to help them to understand how their trainees will be expected to perform by the end of core training and to strengthen the robustness of their own assessments during supervision. We will be advertising these opportunities shortly, so look out for this if you are interested.

Psychiatry has the MRCPsych examination as the principal summative assessment of satisfactory completion of core specialist training. This, we believe, remains a reliable and essential test of the acquisition of the knowledge and competencies expected of a psychiatrist who is ready to progress to higher training. The current rating system for WPBAs in Assessments Online, however, does not sufficiently emphasise the essentially formative function of the process. As a consequence, many trainers have found it difficult to give robust and honest feedback and we have all become aware of the phenomenon of the trainee with a portfolio of perfect WPBA scores, baffled by their failure to pass the CASC exam. We are investigating ways of making the scoring system simpler and more aligned with judgements based on satisfactory development of competences in maintaining patient safety.

Workplace-based assessments, if used correctly, can be a powerful formative training tool. At the very least, they provide an opportunity for trainees to have their practice and competencies observed in a protected and structured manner. The challenge for trainers, the College and trainees themselves is to embrace the cultural training change that WPBAs represent so that they are used to support effective training. Workplace-based assessments are primarily a tool for helping an experienced clinician give robust and valid feedback to another clinician. To treat them as a tick-box exercise is to miss the point and lose their value. Those of us responsible for guiding members and trainees through the new training mechanisms have probably not been sufficiently clear or realistic about what is expected from trainers and trainees and there has certainly been a lack of clarity about the overwhelmingly formative function of WPBAs. For this we are sorry. We are learning too, and hope that the changes that we have outlined in this letter will move things forward. The College, too, must expect to receive robust and valid feedback about training initiatives, and we hope that colleagues will continue to survey trainer and trainee experiences and that we will be seen to act constructively and purposefully in response. We all want the highest possible quality training for psychiatrists and have to make the best use of the tools available.