Workplace-based assessments need trainer consistency.

Abstract

Despite their many criticisms, I am in favour of workplace-based assessments (WPBAs). They do, in theory, assess a range of important skills and do this outside of stressful examination conditions, thereby allowing trainees to perform to their greatest ability. The Assessment of Clinical Expertise (ACE) in particular covers many of the same skills assessed in the long case but avoids the snapshot examination the latter was often criticised for. The ACE overcomes this by assessing patients across multiple specialties with varying patient groups and attempts to minimise examiner bias by requiring completion from a number of different trainers. It also supersedes the long case by allowing full observation of the patient encounter and so in addition to assessing diagnostic and management skills, provides a more reliable means of assessment of communication skills and the ability of the trainee to develop a rapport with their patient. As a trainee, however, I can clearly see that WPBAs are not without their problems. The main concern for myself and many trainees alike is not with their format or the skills they assess, but rather the rating and feedback. There is lack of consistency among trainers in completing these forms with no standards of reference to work to and so there is great subjectivity in their completion. Perhaps the introduction of external assessors who have received further training could be a step forward in overcoming such inconsistencies.