ARE WORKPLACE-BASED ASSESSMENTS FAILING TO AID LEARNING IN THE WORKPLACE FOR SURGICAL TRAINING?

Surgical training in the United Kingdom (UK) has undergone vast changes in recent years in response to various reviews. In addition, the introduction of the European Working Time Directive (EWTD), changes in the delivery of surgical care, and increased emphasis on accountability and transparency have all changed the landscape for surgical training. A qualitative study by the General Medical Council in 2011 found that the EWTD has had a negative effect on medical training in the UK. The duration of surgical training is now shorter with increased service provision and significantly reduced training time. The changes have also meant the traditional apprenticeship model of surgical training has been replaced with a shift system of working with a more fragmented workforce. Thus, there has been a need to change the way surgical training is delivered. The need for maximising training and learning opportunities led to the development of competency-based surgical curricula with the Intercollegiate Surgical Curriculum Programme (ISCP) being implemented in 2007. Workplace-based assessments (WBAs) form a central part of the ISCP and are competence-based with an emphasis on continuous assessment for learning. In recent years, theoretical perspectives on workplace-based learning (WBL) have moved away from traditional theories emphasising individual learners towards socio-cultural learning theories. These emphasise collective learning with less distinction between learning and working. That is, learning is an integral part of our everyday practice and experience. Based on socio-cultural theories of learning and the concept of recontextualisation, WBAs can be powerful tools for maximising learning opportunities in the workplace. However, given the multipurpose use of WBAs and lack of effective feedback, WBAs largely fail at present to effectively aid learning. Workplace factors that affect the effective use of WBAs for learning can be divided into individuals (trainee and trainer motivation; understanding of WBAs and their aims; lack of feedback), organisation (service provision; allocation of time for consultants to train trainees; amount of theatre time per elective case) and professional groups (ISCP design of WBAs and guidance; deanery requirements for Annual Review of Competence Progression; national selection for specialty training; rota design and EWTD). Learning requires common goals, effective feedback and a supportive workplace. Aligning understanding of the role of WBAs including the need for effective feedback present key areas where improvements can be made to enhance WBL. This can help to nurture a supportive workplace learning environment with WBAs as power tools for learning. Further studies are required to optimise the utilisation of WBAs for surgical training in the UK.