The role and value of workplace-based assessment in learning in postgraduate medical education

Abstract

Introduction Workplace-based assessment (WBA) has been the subject of much debate since its introduction; it remains unclear whether the intended learning value of these tools has been realised. The purpose of this thesis to establish what is the role and value of workplace-based assessment in learning in postgraduate medical education? Methods A retrospective cohort study was designed to establish how WBA has been implemented in six Irish training bodies and to explore the value of the documented information. This was followed by a phenomenological study of trainers’ and trainees’ experiences of WBA and how their perceptions of the learning value of WBA have been shaped. The value of WBA in identifying and/or remediating underperformance was explored using the Best Evidence in Medical Education (BEME) systematic review methods. Results The cohort study revealed a familiar picture of WBA as a ‘tick-box’ exercise. The learning value associated with WBA proved complex to elicit, however trainees associated WBA with training value and a justifiable way to ask for feedback and time with trainers. The BEME review identified 20 relevant studies but could not definitively establish the optimal implementation conditions for identifying or remediating underperformance. Discussion The findings suggest that it is the practice of formative assessment that is of learning value to trainees and not the individual WBA tools. The study also demonstrated that there is a potential learning value in affirmation of good practice and that ‘learning’ is a complex concept. Determining effectiveness of WBA in identifying or remediating underperformance was limited by lack of high quality prospective studies. Conclusion The value of WBA to its users is influenced by experience and is complex to articulate. Ongoing work is needed to normalise the assessment-feedback process and to influence a positive learning trajectory.