Workplace-based assessment: A step to promote competency based postgraduate training

There has been an increasing emphasis on defining outcomes of medical education in terms of ‘performance’ of trainees. This is a step beyond the description of outcomes in terms of ‘competence’ that encompasses mostly ‘potential abilities’ rather than the ‘actual performance’. The contextual adaptations and behavior judgments of the trainees are best assessed by a program of in-training assessment. Workplace based assessment (WPBA) is one of the modalities, which assesses the trainee in authentic settings. Though Postgraduate (PG) medical training in India is said to be competency-based, most institutions do not have any formative or in-training assessment program for the same. The two cardinal elements of WPBA are ‘direct observation’ and ‘conducted in work place’ in addition to provision of ‘feedback’ to the trainee. The WPBA conforms to the highest (Level 4: ‘Does’) of Miller’s pyramid and also has the potential to assess at all four levels. Some of the tools used for WPBA are: Logbooks, Clinical Encounter Cards (CEC), mini-Clinical Evaluation Exercise (mini-CEX), Case based discussions, Direct Observation of Procedural Skills (DOPS), Multisource feedback (peers, co-workers, seniors, patients) etc. These can be documented in the form of a portfolio that provides a longitudinal view of experiences and progress of the trainee. The WPBA scores high on validity and educational impact by virtue of being based on direct observation in real situation and contextual feedback. The feasibility and acceptability is enhanced by making appropriate choices of tools, advance planning, building of mutual trust, and training of assessors. Given the established benefits of WPBA in shaping clinical learning, there is an imminent need for including this mode of assessment in our clinical training programs especially PG training.