Workplace-based Assessment Tools Research Articles

Assessment methods in respiratory medicine training in Europe: current status and future needs.

There is a perceived need for harmonisation of training standards in medicine across Europe. Assessment methodology is a fundamental part of this harmonisation. Assessment may be: summative, measuring competency at the end of training, usually in a pass/fail mode; or formative, assessing strengths and weaknesses during training with a view to optimising performance. A survey of experienced respiratory medicine trainers in Europe was undertaken to discover the formative and summative assessment methods being used, and to explore the use of workplace-based assessments (WBAs). Structured interviews were sought with experienced trainers in adult and paediatric respiratory medicine. 35 trainers from 22 (71%) out of 31 countries were interviewed.The number of types of summative assessments required at the end of training varied from 0 to 4 including clinical (25%), written (44%) and oral (47%) examinations. Four respondents required a research thesis as a proof of clinical competence.WBA was not commonly used. Only 14% of respondents reported using a formal case-based discussion, 20% used a form of multisource feedback and 25% described some form of formal assessment of procedural skills. However, 77% of all respondents expressed a wish to have access to case-based discussion and 72% wanted to have a facility for multisource feedback. The majority also wanted training in the use of these tools. Almost half of the respondents had received no formal training in educational supervision and 80% of all respondents expressed a wish to receive such training.The findings suggest that there is no adequate process of ensuring uniform standards for specialist accreditation in Europe, and demonstrate a need and desire among trainers for more WBA tools and training in their use to be made available.

Myths and legends in workplace-based assessment; it’s all about perspective?

ABSTRACTBased on internationally published literature and the experience of the project team, we understood that already established beliefs and perceptions could influence the implementation of new workplace-based assessment (WBA) tools and processes. At the start of a project to design new WBA tools, we, therefore, attempted to understand the perspectives and perceptions of our GP training community and inform the communication strategy for the project. Online and paper surveys were disseminated to GP trainers, trainees and programme directors. Data were extracted from SurveyMonkey, added to paper-based data in an Excel spreadsheet and analysed using descriptive statistics. While it was generally acknowledged that trainers provide regular feedback to trainees, perceptions of the quality of feedback varied between the groups. The majority of participants agreed that WBA would be of value in learning but expressed concerns over increased workload. There were also some misconceptions about the purpose of WBA, with trainees stating they understood WBAs to be valid and reliable as a single-event sign-off tool. Differences in trainer, trainee and programme director perceptions of the use and usefulness of WBA may be attributed to many factors, not least of all (lack of) experience, perspective and position.

Workplace based assessment: A review of available tools and their relevance.

Workplace-based assessment (WPBA) appears to be a promising tool for more comprehensive assessment of the learners. Relevant literature in this direction was collated and analyzed for its relevance, salience, and merit. Many WPBA tools are being used by various educational institutions which spans across multiple domains and over the entire duration of the workplace learning. It caters to holistic assessment with structured measures, real-time feedback, and continuous professional development. It is being used more for formative assessment and has limited utility in summative assessment as on date. WPBA tools have promising prospect in bringing novelty, objectivity, and holistic approach in assessment.

Use of Mini Clinical Evaluation Exercise as a Tool to Assess the Orthodontic Postgraduate Students

Introduction: The mini CEX (Clinical Evaluation Exercise) is a workplace-based assessment tool intended to assess the clinical performance and a range of other skills such as communication skills, clinical judgment, professionalism, efficiency, and the overall clinical care while directly observing a real patient encounter. The clinical sessions are followed by structured feedback sessions between the assessors and the trainees. Mini CEX focuses on the actual performance and not just knowledge. This leads to better learning as well as helps to develop and strengthen the doctor–patient bond. Materials and Methods: 8 staff members and 9 orthodontic postgraduate students volunteered to participate in this study after the orientation session was taken to sensitize them about the same. An informed consent was taken from all of them. All the students had 2 sessions with all the assessors. As per the protocol of Mini CEX, immediate feedback about their performance was given to the students after each session. Feedback was also obtained from the assessors and the students after the completion of the exercise. This feedback allowed the assessors and the students to give their views on the exercise. Result: Mean scores of all the students significantly improved in the second session as compared to the first encounter. This was attributed to the feedback which they obtained from the assessors immediately after the session, which helped them improvise on various aspects of patient care. The students themselves felt that the exercise helped them learn better. Conclusion: Mini CEX can hence be considered as a valid formative assessment tool which when routinely used could enhance the learning experience, improve the communication skills of the students, as well as improve the doctor–patient bond.

Providing quality feedback to general internal medicine residents in a competency-based assessment environment

Construct: Competence Based Medical Education (CBME) is designed to use workplace-based assessment (WBA) tools to provide observed assessment and feedback on resident competence. Moreover, WBAs are expected to provide evidence beyond that of more traditional mid- or end-of-rotation assessments [e.g., In Training Evaluation Records (ITERs)]. In this study we investigate competence in General Internal Medicine (GIM), by contrasting WBA and ITER assessment tools.Background: WBAs are hypothesized to improve and differentiate written and numerical feedback to support the development and documentation of competence. In this study we investigate residents’ and faculty members’ perceptions of WBA validity, usability, and reliability and the extent to which WBAs differentiate residents’ performance when compared to ITERs. Approach: We used a mixed methods approach over a three-year period, including perspectives gathered from focus groups, interviews, along with numerical and narrative comparisons between WBA and ITERs in one GIM program.Results: Residents indicated that the narrative component of feedback was more constructive and effective than numerical scores. They perceived the focus on specific workplace-based feedback was more effective than ITERs. However, quantitative analysis showed that overall rates of actionable feedback, including both ITERs and WBAs, were low (26%), with only 9% providing an improvement strategy. The provision of quality feedback was not statistically significantly different between tools; although WBAs provided more actionable feedback, ITERs provided more strategies. Statistical analyses showed that more than half of all assessments came from 11 core faculty.Conclusions: Participants in this study viewed narrative, actionable and specific feedback as essential, and an overall preference was found for written feedback over numerical assessments. However, quantitative analyses showed that specific actionable feedback was rarely documented, despite qualitative emphasis from both groups of its importance for developing competency. Neither formative WBAs or summative ITERs clearly provided better feedback, and both may still have a role in overall resident evaluation. Participant views differed in roles and responsibilities, with residents stating that faculty should be responsible for initiating assessments and vice-versa. These results reveal a disconnect between resident and faculty perceptions and practice around giving feedback and emphasize opportunities for programs adopting and implementing CBME to address how best to support residents and frontline clinical teachers.

Entrustable professional activities (EPAs) for postgraduate competency based intensive care medicine training in the Netherlands: The next step towards excellence in intensive care medicine training

IntroductionThe Competency Based Training in Intensive Care Education (CoBaTrICE) programme developed common standards of ICM training by describing competencies of an intensivist. Entrustable Professional Activities (EPAs) of Intensive Care Medicine (ICM) (EPAsICM) are presented as a new workplace-based assessment tool in competency-based training of intensivists. EPAs are activities to be entrusted to a trainee once he (or she) has attained competence. EPAs emphasise the role of trust between trainees and supervisors. EPAs bridge the gap between competencies and competence. MethodsAn expert panel of ICM (vice)programme directors and intensivists in The Netherlands integrated the CoBaTrICE and CanMEDS competencies into EPAsICM. Comment and feedback was sought from other ICM programme directors and educational experts and processed in the final version of EPAsICM before implementation in the Dutch ICM training programme. ResultsA list of 15 EPAsICM are considered to reflect the spectrum of clinical practice while incorporating the competencies of CoBaTrICE and CanMEDS. The grading system is designed as a 5-point entrustment scale based on the amount of supervision a trainee needs, aligning with daily judgement of trainees by intensivists. ConclusionEPAsICM is an assessment tool that formalises entrustment decisions and can be a valuable addition in international ICM training.

Workplace-Based Assessments Using Pediatric Critical Care Entrustable Professional Activities.

Workplace-based assessment (WBA) is critical to graduating competent physicians. Developing assessment tools that combine the needs of faculty, trainees, and governing bodies is challenging but imperative. Entrustable professional activities (EPAs) are emerging as a clinically oriented framework for trainee assessment. We sought to develop an EPA-based WBA tool for pediatric critical care medicine (PCCM) fellows. The goals of the tool were to promote learning through benchmarking and tracking entrustment. A single PCCM EPA was iteratively subdivided into observable practice activities (OPAs) based on national and local data. Using a mixed-methods approach following van der Vleuten's conceptual model for assessment tool utility and Messick's unified validity framework, we sought validity evidence for acceptability, content, internal structure, relation to other variables, response process, and consequences. Evidence was gathered after 1 year of use. Items for assessment were based on correlation between the number of times each item was assessed and the frequency professional activity occurred. Phi-coefficient reliability was 0.65. Narrative comments demonstrated all factors influencing trust, identified by current literature, were cited when determining level of entrustment granted. Mean entrustment levels increased significantly between fellow training years (P = .001). Compliance for once- and twice-weekly tool completion was 50% and 100%, respectively. Average time spent completing the assessment was less than 5 minutes. Using an EPA-OPA framework, we demonstrated utility and validity evidence supporting the tool's outcomes. In addition, narrative comments about entrustment decisions provide important insights for the training program to improve individual fellow advancement toward autonomy.

Involving ophthalmology departmental stakeholders in developing workplace-based assessment tools

ObjectiveAs competency-based medical education (CBME) rolls out across Canada, the assessment process is changing. Our purpose was to involve stakeholders in the selection and modification of workplace-based assessment (WBA) tools for use in an ophthalmology residency program. DesignThis is a qualitative case study conducted in one ophthalmology department at a midsized teaching hospital in eastern Ontario. ParticipantsOphthalmology faculty and residents within the Emergency Eye Clinic participated in the study. MethodsPhase 1 consisted of faculty piloting the tools and providing written feedback. Phase 2 consisted of 2 focus groups, 1 for residents (n = 9) and 1 for faculty (n = 6), to explore their experiences with the 4 piloted adapted WBA tools. ResultsResidents and faculty discussed ongoing issues with buy-in and formalizing feedback through the new assessment process. Residents also reiterated the need for more constructive feedback delivered in a timely and sensitive manner. Generally, residents did not value numerical scales on the tools and preferred written comments. Both residents and faculty valued oral over written feedback given the interactive nature of oral feedback. ConclusionsThis study provides insight into faculty and resident perspectives about WBA tools within one ophthalmology department. These results informed the development of WBA tools within the department and highlighted the importance of shifting the assessment culture to accommodate programmatic approaches to assessment in CBME. Involving key stakeholders in the change process has been a valuable strategy. Future research should examine whether or not these perspectives change after CBME implementation.

Faculty and Resident Perspectives on Using Entrustment Anchors for Workplace-Based Assessment.

Research suggests that workplace-based assessment (WBA) tools using entrustment anchors provide more reliable assessments than those using traditional anchors. There is a lack of evidence describing how and why entrustment anchors work. The purpose of this study is to better understand the experience of residents and faculty with respect to traditional and entrustment anchors. We used constructivist grounded theory to guide data collection and analysis (March-December 2017) and semistructured interviews to gather reflections on anchors. Phase 1 involved residents and faculty (n = 12) who had only used assessment tools with traditional anchors. Phase 2 involved participants who had used tools with entrustment anchors (n = 10). Data were analyzed iteratively. Participants expressed that the pragmatic language of entrustment anchors made WBA (1) concrete and justifiable; (2) transparent as they explicitly link clinical assessment and learning progress; and (3) align with training outcomes, enabling better feedback. Participants with no prior experience using entrustment anchors outlined contextual concerns regarding their use. Participants with experience described how they addressed these concerns. Participants expressed that entrustment anchors leave a gap in assessment information because they do not provide normative data. Insights from this analysis contribute to a theoretical framework of benefits and challenges related to the adoption of entrustment anchors. This richer understanding of faculty and resident perspectives of entrustment anchors may assist WBA developers in creating more acceptable tools and inform the necessary faculty development initiatives that must accompany the use of these new WBA tools. .

Assessment Tools for Feedback and Entrustment Decisions in the Clinical Workplace: A Systematic Review.

BACKGROUND: Entrustable Professional Activities (EPAs) combine feedback and evaluation with a permission to act under a specified level of supervision and the possibility to schedule learners for clinical service. This literature review aims to identify workplace-based assessment tools that indicate progression toward unsupervised practice, suitable for entrustment decisions and feedback to learners. METHODS: A systematic search was performed in the PubMed, Embase, ERIC, and PsycINFO databases. Based on title/abstract and full text, articles were selected using predetermined inclusion and exclusion criteria. Information on workplace-based assessment tools was extracted using data coding sheets. The methodological quality of studies was assessed using the medical education research study quality instrument (MERSQI). RESULTS: The search yielded 6,371 articles (180 were evaluated in full text). In total, 80 articles were included, identifying 67 assessment tools. Only a few studies explicitly mentioned assessment tools used as a resource for entrustment decisions. Validity evidence was frequently reported, and the MERSQI score was 10.0 on average. CONCLUSIONS: Many workplace-based assessment tools were identified that potentially support learners with feedback on their development and support supervisors with providing feedback. As expected, only few articles referred to entrustment decisions. Nevertheless, the existing tools or the principals could be used for entrustment decisions, supervision level, or autonomy.

Exploring How the New Entrustable Professional Activity Assessment Tools Affect the Quality of Feedback Given to Medical Oncology Residents.

The post-graduate medical programs at Queen's University transitioned to a competency-based medical education framework on July 1, 2017. In advance of this transition, the Medical Oncology program participated in a pilot of six Entrustable Professional Activities (EPAs) focused workplace-based assessment (WBA) tools with faculty and residents. The purpose of this sequential explanatory mixed method study was to determine the extent to which these WBAs provided quality feedback for residents. The WBAs were introduced into daily clinical practice and, once completed, were collected by the research team. A resident focus group (n = 4) and faculty interviews (n = 5) were also conducted. Focus group and interview data were analyzed using an emergent thematic analysis. Data from the completed assessment tools were analyzed using both descriptive statistics and a literature-informed framework developed to assess the quality of feedback. Six main findings emerged: Verbal feedback is preferred over written; providing both written and verbal feedback is important; effective feedback was seen as timely, specific, and actionable; the process was conceptualized as coaching rather than high stakes; there were logistical concerns about the WBAs, and additional clarification about the WBA tools is needed. This study provides insight into faculty and resident perceptions of quality feedback and the potential for WBA tools to assist in providing effective feedback to residents as we shift to competency-based medical education in Canada. Our results suggest the need for additional faculty development around the use of the tools, and their intended role, and the elements of quality feedback.

Adaptation of Direct Observation of Procedural Skills (DOPS) for assessments in podiatry

Background: The Direct Observation of Procedural Skills (DOPS) is a workplace-based assessment tool widely used in medicine to assess a learner’s ability to execute a technical skill. The aim of this paper is to report on the development phase of the adaptation of the DOPS for the assessment of podiatry learners’ procedural skills. Podiatry learners are required to practise and demonstrate a variety of procedural skills in the management of foot complaints. Such skills include the use of scalpel blades, needles and local anaesthetic applied to a variety of disorders. The DOPS provides an avenue by which a learner’s procedural skills can be assessed and timely feedback provided in the workplace or in simulated environments. Methods: The DOPS was initially adapted for podiatry by a faculty team consisting of a podiatry educator, a clinical education specialist and a clinical educator from another allied health discipline. The first iteration was circulated among podiatry faculty at three other Australian universities. The second iteration was reviewed by clinical supervisors from Southern Cross University (SCU). The third iteration was administered by two clinical supervisors at SCU working with 12 learners during real-time clinical events. Eleven learners used DOPS to assess their peers during five real-time and six simulated learning events. Results: A new tool, the Direct Observation of Procedural Skills in Podiatry (DOPS-P) has emerged from this process. Face and construct validity have been confirmed, and faculty and students consider DOPS-P contributes to learning. Conclusions: Further research is necessary to confirm the validity and reliability of the DOPS-P to support assessment decisions about students’ achievement of podiatry competencies.

Composite reliability of workplace-based assessment of international medical graduates.

The fitness to practise of international medical graduates (IMGs) is usually evaluated with standardised assessment tests. The performance rather than the competency of practising doctors should, however, be assessed, for which reason workplace-based assessment (WBA) has gained increasing attention. Our aim was to assess the composite reliability of WBA instruments for assessing IMGs. Between June 2010 and April 2015, 142 IMGs were assessed by 99 calibrated assessors; each was assessed in the workplace over 6 months. The IMGs completed 970 case-based discussions (CBDs), 1741 mini-clinical examination exercises (mini-CEX), and 1020 multi-source feedback (MSF) assessments. 103 male and 39 female candidates from 28 countries (Africa, Asia, Europe, South America, South Pacific) in urban and rural hospitals of the Hunter New England Health region. The composite reliability across the three WBA tools, expressed as the standard error of measurement (SEM). In our WBA program, a combination of five CBD and 12 mini-CEX assessments achieved an SEM of 0.33, greater than the threshold 0.26 of a scale point. Adding six MSF results to the assessment package reduced the SEM to 0.24, which is adequately precise. Combining data from different WBA assessment instruments achieves acceptable reliability for assessing IMGs, provided that the panel of WBA assessment types are carefully selected and the assessors are calibrated.

The use of portfolio to support competency-based professional development of pharmacists in a Singapore tertiary hospital.

This article was migrated. The article was marked as recommended. Competency frameworks is implemented to support continuing professional development in an academic medical centre, with the aims of establishing and retaining a competent pharmacist workforce; and is described using Kotter's change management framework. The desire to provide a clear developmental route with defined criteria to identify and bridge competency gaps through systematic training of our pharmacists and meeting JCI requirements for documented continued competence gave impetus to the establishment of the General and Advanced Level Frameworks. To aid implementation, a series of roadshows were organized to communicate the vision to pharmacists and experts from the UK were invited to share experience and to "train-the-trainers". Clinical groups were set up to provide learning platforms for the advanced pharmacist practitioners to coach the pharmacists. Competency assessment was conducted biyearly using workplace based assessment tools. Formative feedback was provided post-assessment and learning objectives and training plan for the next assessment cycle would be discussed. The implementation of competency frameworks provides an opportunity for pharmacists to identify competency gaps and plan their training and development to achieve higher standards of practice. The portfolio and competency-based developmental frameworks enable systematic approach to evaluate and facilitate performance management.

Workplace assessment in crisis? – The way forward

IntroductionA recent Royal College of Physicians’ (RCP) study on assessment raises serious questions for workplace assessment. To address these, a system that bridges the gap from competence to performance and integrates supervised learning events (SLEs) that are formative in purpose with summative assessment of performance by entrustable professional activities (EPAs) is recommended.Aims and objectivesAs a working group on assessment in psychiatry, we were interested in the RCP findings which represent a significant milestone in studies of workplace assessment. The RCP aims were to evaluate the feasibility, validity and educational value of using existing WPBA tools but for different assessment purposes and processes.ResultsThese were based on the General Medical Council (GMC) working party on assessment. The RCP revised its assessment processes to differentiate between assessments of development and performance. The former are formative and aim to identify a trainee's areas of strength and development; the latter are summative and aim to determine fitness to progress. Of note is that the same workplace based assessment (WPBA) tool can be used for each type of assessment; the assessment's purpose is the discriminating factor.ConclusionsInitial design of the requisite EPAs requires value judgments by trainers and trainees alike on what represent core units of work. EPAs can contribute directly and more meaningfully to ARCP progression decisions.RecommendationsInclusion of the required level of supervision as part of SLE feedback enables future decisions on meeting performance standards.Trainee/trainerInteraction in this educational process.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Implementation of a Mini-Clinical Evaluation Exercise (Mini-CEX) Program to Assess the Clinical Competence of Postgraduate Trainees in Pediatrics.

To implement Mini-CEX, a Workplace-based assessment tool, for formative assessment of clinical skills of final year pediatric post-graduate residents. All final-year postgraduate residents at the Department of Pediatrics of a public medical college in India underwent mini-CEX assessment by rotation among six faculty members. Outcome was assessed by an anonymous questionnaire-based feedback from the participating students and faculty members, collected after the completion of all the mini-CEX encounters. 20 final year postgraduate students (12 males, 15 MD and 5 DCH) were assessed. Data gathering (68.7%) and counseling (63.3%) were the most common areas assessed. 84% and 58% of the students and faculty, respectively were satisfied with their Mini-CEX encounter (score > 8 on a 10-point Likert scale). 90% of the participating students felt that Mini-CEX should be included as a routine in postgraduate teaching. All six faculty thought they had a good experience, but 50% were unsure whether it was a valid method of assessment. The involved faculty and residents had high satisfaction levels with mini-CEX evaluation. Mini-CEX has a potential to be incorporated in the formative evaluation of postgraduate pediatric students as part of the workplace-based assessment.

Composite reliability of workplace-based assessment for international medical graduates.

The fitness to practise of international medical graduates (IMGs) is usually evaluated with standardised assessment tests. Practising doctors should, however, be assessed on their performance rather than their competency, for which reason workplace-based assessment (WBA) has gained increasing attention. Our aim was to assess the composite reliability of WBA instruments for assessing the performance of IMGs. Between June 2010 and April 2015, 142 IMGs were assessed by 99 calibrated assessors; each cohort was assessed at their workplace over 6 months. The IMGs completed 970 case-based discussions (CBDs), 1741 Mini-Clinical Examination Exercises (mini-CEX) and 1020 multisource feedback (MSF) sessions. 103 male and 39 female candidates based in urban and rural hospitals of the Hunter New England Health region, from 28 countries (Africa, Asia, Europe, South America, South Pacific). The reliability of the three WBA tools; the composite reliability of the tools as a group. The composite reliability of our WBA toolbox program was good: the composite reliability coefficient for five CBDs and 12 mini-CEX was 0.895 (standard error of measurement, 0.138). When the six MSF results were included, the composite reliability coefficient was 0.899 (standard error of measurement, 0.125). WBA is a reliable method for assessing IMGs when multiple tools and assessors are used over a period of time. This form of assessment meets the criteria for "good assessment" (reliability ≥ 0.8) and can be applied in other settings.

A New Instrument for Assessing Resident Competence in Surgical Clinic: The Ottawa Clinic Assessment Tool

The shift toward competency-based medical education has created a demand for feasible workplace-based assessment tools. Perhaps, more important than competence to assess an individual patient is the ability to successfully manage a surgical clinic. Trainee performance in clinic is a critical component of learning to manage a surgical practice, yet no assessment tool currently exists to assess daily performance in outpatient clinics for surgery residents. The development of a competency-based assessment tool, the Ottawa Clinic Assessment Tool (OCAT), is described here to address this gap. A consensus group of experts was gathered to generate dimensions of performance reflective of a competent "generalist" surgeon in clinic. A 6-month pilot study of the OCAT was conducted in orthopedics, general surgery, and obstetrics and gynecology with quantitative and qualitative evidence of validity collected. In all, 2 subsequent feedback sessions and a survey for staff and residents evaluated the OCAT for clarity and utility. The OCAT is a 9-item tool, with a global assessment item and 2 short-answer questions. Among the 2 divisions, 44 staff surgeons completed 132 OCAT assessments of 79 residents. Psychometric data was collected as evidence of validity. Analysis of feedback indicated that the entrustability rating scale was useful for surgeons and residents and that the items could be correlated with individual competencies. Multiple sources of validity evidence collected in this study demonstrate that the OCAT can measure resident clinic competency in a valid and feasible manner.

Reliability of the direct observation of procedural skills assessment tool for ultrasound-guided regional anaesthesia.

The Direct Observation of Procedural Skills (DOPS) form is used as a workplace-based assessment tool in the current Australian and New Zealand College of Anaesthetists curriculum. The objective of this study was to evaluate the reliability of DOPS when used to score trainees performing ultrasound-guided regional anaesthesia. Reliability of an assessment tool is defined as the reproducibility of scores given by different assessors viewing the same trainee. Forty-nine anaesthetists were recruited to score two scripted videos of trainees performing a popliteal sciatic nerve block and an axillary brachial plexus block. Reliability, as measured by intraclass correlation coefficients, was -0.01 to 0.43 for the individual items in DOPS, and 0.15 for the 'Overall Performance for this Procedure' item. Assessors demonstrated consistency of scoring within DOPS, with significant correlation of sum of individual item scores with the 'Overall Performance for this Procedure' item (r=0.78 to 0.80, P<0.001), and with yes versus no responses to the 'Was the procedure completed satisfactorily?' item (W=24, P=0.0004, Video 1, and W=65, P=0.003, Video 2). While DOPS demonstrated a good degree of internal consistency in this setting, inter-rater reliability did not reach levels generally recommended for formative assessment tools. Feasibility of the form could be improved by removing the 'Was the procedure completed satisfactorily?' item without loss of information.

Entrustability Scales: Outlining Their Usefulness for Competency-Based Clinical Assessment.

Meaningful residency education occurs at the bedside, along with opportunities for situated in-training assessment. A necessary component of workplace-based assessment (WBA) is the clinical supervisor, whose subjective judgments of residents' performance can yield rich and nuanced ratings but may also occasionally reflect bias. How to improve the validity of WBA instruments while simultaneously capturing meaningful subjective judgment is currently not clear. This Perspective outlines how "entrustability scales" may help bridge the gap between the assessment judgments of clinical supervisors and WBA instruments. Entrustment-based assessment evaluates trainees against what they will actually do when independent; thus, "entrustability scales"-defined as behaviorally anchored ordinal scales based on progression to competence-reflect a judgment that has clinical meaning for assessors. Rather than asking raters to assess trainees against abstract scales, entrustability scales provide raters with an assessment measure structured around the way evaluators already make day-to-day clinical entrustment decisions, which results in increased reliability. Entrustability scales help raters make assessments based on narrative descriptors that reflect real-world judgments, drawing attention to a trainee's readiness for independent practice rather than his/her deficiencies. These scales fit into milestone measurement both by allowing an individual resident to strive for independence in entrustable professional activities across the entire training period and by allowing residency directors to identify residents experiencing difficulty. Some WBA tools that have begun to use variations of entrustability scales show potential for allowing raters to produce valid judgments. This type of anchor scale should be brought into wider circulation.