conducting workplace based assessments philip dacosta consultant histopathologist member, rcpath wba...

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

ActionCBD

ECE

Mini-CEX

DOPS

Mini-PAT

DOPS ECE Mini-CEX CbD

Real time - HOW people do their work Reflective - WHY they did what they did

Consider the focus of the assessment

DOPS ECE Mini-CEX

CbD

Real time - HOW people do their workReflective - 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

Minimum 6 per year

Minimum 6 per year

Histopathology 3 during training

Minimum 6 per year up to end of stage C

Minimum 6 per year

Minimum 6 per year

-

Medical Microbiology & Virology

3 during training

Minimum 6 per year

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


Assessment process

Feedback


trainees

Curriculum


Assessment form



guidance


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


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


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

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


Assessment process

Feedback


trainees

Curriculum


Assessment form



guidance


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


Assessment process

Feedback


trainees

Curriculum


Assessment form



guidance


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

conducting workplace based assessments philip dacosta consultant histopathologist member, rcpath wba...

Documents

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assessment worksstandards

rcpath wba

wba toolaimed

wbaoutline of wba toolswho

wba toolsuitable caseswho

relevant guidance notes

existing structuresday