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Curriculum for workplace-based assessments: a Delphi study

  • Rahul Bhattacharya (a1), Michael Maier (a2), Dinesh Bhugra (a3) and James Warner (a4)
Abstract
Aims and method

To generate a list of topics for ‘core curriculum’ that can be used as a guide for trainees and trainers carrying out workplace-based assessments (WPBAs). A three-stage Delphi consultation was carried out.

Results

Generation of a list of topics for WPBA appropriate for each year of core training with a mean rating of importance in curriculum.

Clinical implications

In the absence of formal guidance, the list generated can serve as an informal guide.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Rahul Bhattacharya (rahul.bhattacharya@nhs.net)
Footnotes
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Declaration of interest

At the time of conducting the consultation D.B. was the Dean of the Royal College of Psychiatrists and M.M. was the Head of the London Specialty School of Psychiatry.

Footnotes
References
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1 Miller, GE. The assessment of clinical skills/performance. Acad Med 1990; 65: S637.
2 Bloom, BS. Taxonomy of Educational Objectives, Handbook I: The Cognitive Domain. David McKay Co., 1956.
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6 Department of Health, Department of Health Social Services and Public Safety, National Health Service. The Gold Guide A Guide to Postgraduate Specialty Training in the UK. Modernising Medical Careers, 2007.
7 Royal College of Psychiatrists. A Competency Based Curriculum for Specialist Training in Psychiatry – Core Module. Royal College of Psychiatrists, 2009.
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10 Broomfield, D, Humphris, GM. Using the Delphi technique to identify the cancer education requirements of general practitioners. Med Educ 2001; 35: 928–37.
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13 Wass, V, Vleuten, CV, Shatzer, J, Jones, R. Assessment of clinical competence. Lancet 2001; 357: 945–9.
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BJPsych Bulletin
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  • EISSN: 1758-3217
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Curriculum for workplace-based assessments: a Delphi study

  • Rahul Bhattacharya (a1), Michael Maier (a2), Dinesh Bhugra (a3) and James Warner (a4)
Submit a response

eLetters

A way forward for workplace-based assessments

Jayne S Greening, consultant psychiatrist, training programme director
21 June 2010

Bhattacharya et al's (1) article makes an important and helpful contribution to using workplace-based assessments (WPBA's)as formative and summative assessment tools for the Annual Review of Competence Progression (ARCP). They have rightly pointed out that while the college recommendations on minimum numbers of assessments required at the end of each year are clear,there is little direct guidance as to what should be assessed at each stage.The authors correctly point out the potential gap between the curriculum and the ARCP process and the need to ensure the WPBA process does not become a tick-box exercise.The method of choosing which topics should be assessed at which stage using the Delphi method and involving many key stakeholders seems robust. The topics generated have face validity and can be mapped onto the curriculum.The use of continuous assessment in the form of WPBA's as well as high stakes exams should increase the reliability and validity of the assessment system for doctors overall.Potential sources of variance in reliability of WPBA's include; domain specificity(content),assessors, patients or clinical topic. Although standardisation of each individual item in an assessment is important as illustrated by Observed Structured Clinical Examinations (OSCE's), what has become apparent is that reliability of these assessments was more heavily increased by the sampling: The fact participants rotated through several stations (ensuring adequate content sampling) and through several examiners (reducing examiner bias)has had a greater influence on the reliability of the assessment than the standardisation of each individualstation.(2)However there is still a way to go to ensure reliability and validity of WPBA's.It is clear that the CASC pass rate is very low and trainees who seem to be performing well on WPBA's and at ARCP are falling at the hurdle of the clinical exam.

We are continuing to run WPBA training for trainers locally which should help to reduce common errors of assessors being too harsh or much more frequently; too lenient. We are encouraging assessors to mark trainees according to the way in which the forms are designed, against competencies achieved at the end of the year.This however represents a cultural shift of how trainees were traditionally assessed and the feedback from trainers on the WPBA in-house training is often negative.In addition it has become clear that many trainers are uncomfortable with giving constructive feedback and do not have any framework for delivery of feedback.I and any many others will welcome this article in developing a more robust domain framework for WPBA's to help plan the ARCP process. My concerns however remain around assessors and their ability to provide adequate constructive feedback to trainees that are destined to fail the CASC despite seemingly doing well elsewhere. The WPBA's should be picking up these trainees early on and I am pleased that communication skills is featured in many of the topic lists at each stage. I would suggest however that it should feature at all stages in all clinical assessments.I am pleased the college has now added an "area's of concern" document for WPBA's (rcpsych.ac.uk/training) along the lines of that produced for the CASC. This in itself will help provide a framework for feedback.I for one will be informing my CT1 trainees that they may wish to give this form to the trainer at the start of the WPBA.

Declaration of Interest ;none

References

1 Bhattacharya R. Maier M. Bhugra D. Warner J.Curriculum for workplace-based assessments: a Delphi study.2010; The Psychiatrist 34 52 Van der Vleuten CPM. Schwirth LW. Assessing Professional Competence:from methods to programmes. 2005. Medical Education 39 309-317
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Conflict of interest: None Declared

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