Workplace based assessment (wpba): The way forward in post graduate training

The very first line of the preamble in the guidelines for a competency-based post graduate training program in MD community medicine (MCI 2019 online) states that “the purpose of PG education is to create specialists who would provide high quality health care…”. Focusing on the word specialist here,a specialist in medicine is a physician who is qualified in the given area by advanced training and certification by a specialty examining board and such a person is directly absorbed in the workforce as a specialist. The culmination of such training will produce a competent doctor who conforms to the highest tier of the Millers pyramid of clinical competence. Miller’s pyramid is usually described as having 4 levels; knows, knows how, shows how and does. At the end of PG training the doctor is supposed to be at the level of “does” where the doctor is able to perform tasks independently. The entrustable professional activities in community medicine training can be listed out, which can serve as a foundation for competency based assessments. Entrustable professional activity is a key task that an individual can be trusted to perform in a given health care context, once sufficient competence has been demonstrated.

Historically too much emphasis has been placed on determining whether post graduate students can pass summative exams at the end of three years, and insufficient emphasis on whether they can perform in the role expected of them as practitioners. Therefore to achieve an expert doctor after postgraduate training, we need to clearly define core competencies with appropriate teaching/learning methods and assessments to go with them. It is imperative to gather evidence of clinical competence and professional behavior on a regular basis in the workplace. Workplace based assessment (WPBA) involves direct observation of trainees’ performances at their workplaces followed by providing feedback based on the performance and now it has become an essential part of post graduate evaluation in many countries. The post graduate student can be observed and assessed in real life situations. The possible assessment tools at this level of Miller’s pyramid are multiple. Assessment tools that are commonly used include direct observation, MiniCEx, Multisource Feedback (MSF) and 360 degree evaluation. Standardized patients, computer-based simulation, model-driven simulation and virtual reality/haptic devicesand other methods can all be used to assess “Does” and also some aspects of “Shows How”. This differs from assessments that are traditionally done in postgraduate settings where assessments are usually knowledge-based and summative with little scope to test the psychomotor and affective domain in an effective manner.

Following table is an attempt to present the current assessment practicesand the proposed reforms in assessments for post graduates:

In context to community medicine, the competencies related to research methodology and biostatistics are fulfilled very well with thesis and publications and conference presentations mandated by the university. However, assessment of competencies other than those in the knowledge domain need a serious overhaul. With the release of MCI competency based MD curriculum, change has been initiated. It is time for academicians to read the document critically and align the competencies with more rigorous teaching learning methods and assessment strategies and this can be a real game changer in PG training. 