Defining competence for workplace based assessment – a pragmatic and thorough method

Abstract

Competency based assessment relies on the definition of expected knowledge, skills and attitudes. The lack of adequately defined competencies in the workplace undermines the value of workplace assessment for both trainer and trainee. Rigorous academic methods exist, but are time consuming [1]. A comprehensive, yet practical alternative approach is presented. This two phase method combined semi-structured interviews (phase one) with a modified Delphi technique (phase two) to define competence in the provision of anaesthesia for vascular surgery. Ethical approval was not required for this service development project, although ethical principles were adhered to. Recently appointed consultant anaesthetists were interviewed in the first phase and a heterogeneous group of consultant anaesthetists took part in the Delphi process. The process produced list of competence targets and the objectives defining the performance required for their attainment. Phase one led to the production of four competences and 18 objectives. Sixteen of the 18 objectives were amended by the second phase and 10 additional objectives added. This gave an agreed final list of four competences and 28 objectives. The four defined competences that the trainee should be able to do were: (i) undertake thorough and effective pre-assessment; (ii) conduct safe anaesthesia; (iii) use knowledge, skills and attitudes gained elsewhere; and (iv) communicate effectively. The objectives reflected the changing nature of vascular surgery, addressed non-technical skills and placed added emphasis on pre- and postoperative management. For example, the trainee: should anticipate the likely level of care required postoperatively and communicate these needs with critical care colleagues as appropriate; must be aware of the organisational and managerial aspects of pre-assessment; should understand the role of a multidisciplinary team; and should be aware of models available to achieve high quality assessment, including the functions of a pre-assessment clinic. The competencies and objectives have been utilised by the Northern Schools of Anaesthesia in the production of a workplace assessment tool for post-fellowship trainees. The results demonstrate that the described method is effective in defining competence for workplace assessments. It represents a workable compromise between feasibility and stringent research methodology. It is straightforward to undertake and we believe the results are valid and fit for purpose. Wider implementation could enhance the validity and value of workplace assessments.