Workplace-based assessment and the art of performance

Abstract

Einstein had it half right. He could have said: ‘Not everything that counts can be measured. Not everything that can be measured counts … but keep working at it!’ The challenge we have with assessing generalism, the most complex of medical specialties, is that although we recognise what a good GP is (it's someone we would trust to look after our family, isn't it?) we can't easily define what that means. However, if we want our assessments to be valid, we shouldn't be deterred by what Einstein said but should learn to count more appropriately. Or rather, we should learn to assess more appropriately because with complex abilities that are perceptible but not readily quantifiable, counting is not enough. Nowhere is this more evident than in workplace-based assessment (WPBA) in which qualitative and quantitative techniques coexist, construing the development and assessment of performance as both an art and an evolving science. In this article, we will consider the place of WPBA in the nMRCGP (the GP licensing examination), the culture change in assessment and training that WPBA represents,1 and the threats to WPBA's potential benefits. WPBA may be new to GP assessment, but it represents an evolution of the structured trainers report previously used in GP training. WPBA is well tried and tested in non-medical vocational qualifications and is used by other medical Royal Colleges in their licensing examinations. The traditional examination elements of the nMRCGP are the machine-marked applied knowledge test (AKT) and the OSCE-style clinical skills assessment (CSA), which respectively test what a doctor thinks and how they deal with patient problems under simulated conditions. From these, we might draw inferences about how a doctor could perform in real life. WPBA dispenses with the need to infer, by assessing how the doctor actually performs in the workplace, …