This page answers frequently asked questions from RCOG trainers about workplace-based assessments (WPBAs).
For information about how WPBAs are used in the specialty training programme in O&G, and the different types of WPBA, please visit the main WPBA page (aimed at trainees). This page also explains the August 2014 changes to WPBAs.
How many assessments do trainees need to complete?
The evidence base for numbers of procedures necessary to confer competence is not particularly robust. A minimum assessment number (starting by observing cases, then carrying out competences under supervision and, finally, independently), and also regular exposure, is thought to be educationally valid. As we collect data during the first iteration of the new curriculum, we’ll produce evidence that will allow us to adjust the logbook requirements and indicate ‘average numbers’.
In the meantime, we’ve made the training guidelines as flexible as possible, but we do say that trainees should complete three OSATS, assessed by more than one trainer (one of whom should be a consultant), for the core logbook competences that include OSATS.
Why three OSATS?
This is for reliability and validity. Although the curriculum is competency-based and the training guidelines state that a certain number of assessments must be completed, trainers must think out of the box and realise that different trainees will progress at different rates.
However, the reason we’ve designated three as ‘the’ number is to make the process more reliable. Two assessors should be involved in the assessment, one of whom should be a consultant because they will have a more experienced judgement of the trainee’s competence.
Are curriculum and logbook requirements for numbers absolute?
Curriculum and logbook requirements for numbers are for guidance only. It’s obvious that each trainee will develop at a different rate, and some trainees will carry out more supervised procedures than others before their trainer is satisfied that competence has been achieved and the trainee can practise independently. To provide some structure to the delivery of elements of training and to recognise the relative importance of different procedures within the curriculum, suggested numbers of procedures are included in the training documentation.
There is considerable experience in the use of OSATS for the assessment of trainees in O&G. Analysing OSATS (both the content of and, in some respects, the number of OSATS) is particularly important at appraisal time, and particularly at the designated waypoints in the training programme.
Trainees are responsible for organising their workplace-based assessments. The trainee should discuss with their Educational Supervisor the areas in which assessment is required regularly, based on the unit they’re working in and the curriculum requirements at a particular level. Whether a trainee is being assessed by an Educational Supervisor or by another clinical trainer, the trainee should plan ahead so they’re not completing all of the necessary assessments in the lead-up to an appraisal or an annual review. If trainees are struggling to have assessments completed in a unit, they should speak to an Educational Supervisor early and not wait for the appraisal meeting.
Trainees don’t perform OSATS until they’re performing well, or they may throw away or not include ‘bad’ OSATS – what can we do?
Trainees may not pay attention to the clinical trainer’s comments because they choose not to insert it into their ePortfolio. However, trainees should realise that OSATS aren’t a pass/fail process assessment and that OSATS can be formative as well as summative assessments.
There’s no such thing as a ‘bad’ OSATS and there is no such thing as a perfect trainee. Each trainee needs different levels of support, and workplace-based assessments help structure this. Evidence of OSATS undertaken early in training is important for trainers to establish what support a trainee needs and to get a sense of confidence and competence. The aim is not to judge a trainee against another trainee of the same level or a more senior trainee.
Don’t judge a trainee against how you as a clinical trainer used to be when at the same level. Know the curriculum, know the assessments and get to know the trainee.
My trainees only perform OSATS when they’re getting skilful – what can I do?
The trainees are missing the point. Bearing in mind that most trainees fail their ARCP because they have insufficient evidence, surely the more formative evidence, the better? Formative assessment should show progress from basic to advanced level. There’s no point in not completing assessments until competent, because the trainee will miss out on useful structured feedback that will make their life easier.
How can you maximise the case-based discussion?
Use eLearning or other resources before or between case-based discussion assessments for a particular subject area. Make the most of a case-based discussion so that the trainee gains knowledge and has the opportunity to clarify how they would manage a hypothetical situation and ask questions away from patients.
Make sure this is not a tick-box exercise and that trainees realise that training, workplace-based assessment and the MRCOG exams all link together – so the more the trainee can apply their knowledge, the better they will be at their job.
How can you maximise the mini-CEX?
A mini-CEX is a snapshot of a trainee’s interaction with and management of a patient. You don’t need to assess all elements in one situation: a mini-CEX may just focus on improving one particular area of a trainee’s work, for example history taking.
You should give feedback to the trainee after the assessment and identify areas of development and action points. The trainee should also reflect on the experience and make notes, which can be private or shared with an Educational Supervisor or a clinical trainer.
If you have any questions, or need more information, please see the list of contacts in the education and training team at the RCOG, or the A–Z of all useful contacts at the College.