Workplace Based Assessments (WPBA) refer to a group of different assessment methods that are carried out in the workplace and assess different competencies required by the speciality. This article will cover WPBAs in general practice.
WPBAs are used alongside the Applied Knowledge Test and Clinical Skills Assessment to test the remaining professional attributes required from trainees.
WPBAs in medical fields allow trainees to provide evidence of their learning through their daily responsibilities and duties. They also provide an opportunity for feedback identifying their strengths and potential developmental needs.
WPBAs are an integral part of postgraduate medical education and need to be completed for trainees’ progression to a Certificate of Completion of Training (CCT).
It should be noted that there are various WPBAs methods which will be described later on in the article. These methods may be used differently in different specialities and not all methods will be used in each speciality.
This article will focus on the WPBAs required for GPs in their clinical training. WPBAs for GPs cover thirteen capabilities:
Fitness to practice
Maintaining an ethical approach
Communication and consultation skills
Data gathering and interpretation
Clinical examination and procedural skills
Making a diagnosis/decisions
Managing medical complexity
Working with colleagues and in teams
Maintaining performance, learning and teaching
Organisation, management and leadership
Practising holistically, promoting health and safeguarding
Workplace Based Assessment Examples:
Mini-CEX (Mini Consultation Evaluation Exercise): this competency assessment is carried out in the non-primary care setting. The gold standard of assessor is the trainee’s clinical supervisor but ST4 and above doctors and Speciality and Associate (SAS) doctors who meet the GMC assessor requirements can also be assessors. Clinical supervisors should complete a minimum of one Mini-CEX per rotation.
It is best to have different clinical presentations for different Mini-CEXs to show a range of competencies. Mini-CEXs should not last more than fifteen minutes and should be arranged with the assessor in advance of the clinical interaction.
Case-Based Discussion (CbD): this is an oral workplace-based assessment interview where your assessor will assess your clinical judgement in a case you managed on your own. The discussion and feedback should take less than 30 minutes.
Prior to the start of the CbD, trainees must send the clinical information to their assessor and map out the case to three capability areas. It is beneficial to choose different capability areas than the ones used in the past to ensure that all thirteen capabilities are covered.
Clinical Examination and Procedural Skills (CEPS): these are skills that are considered to be essential to be successful and competent within general practice. There is no exhaustive list for these and should be performed based on what the trainee believes is necessary for their skills or based on feedback received from their educational supervisor.
The GMC mandates the following five intimate examinations to be included: breast, male genital examination, female genital examination (speculum and bimanual), rectal and prostate.
As with other examinations, the assessor might be your educational supervisor, ST4 doctor or above or SAS doctors who meet the GMC assessor requirements.
CEPS can be completed as Mini-CEXs, COTs, learning logs or as a CEPS evidence form. There is no set number of CEPS trainees need to do.
Multi-Source Feedback (MSF): this consists of a feedback from ten colleagues- five clinical and five non-clinical. It is understood that some posts may have more clinicians than non-clinicians involved due to the nature of the post.
Candidates must fill in a self-assessment prior to their colleagues sharing feedback. The feedback is anonymous. Once completed by everyone, a workplace based assessment interview will be arranged with your supervisor to allow for feedback, reflection and learning points.
Leadership activity and MSF: this is a requirement for GPST3s and consists of a leadership activity that can be started prior to their ST3 year but should be completed during ST3.
This leadership activity is followed by leadership MSF which is similar to MSF that has been completed in prior stages of training but has more specific questions about the trainee’s leadership.
Patient Satisfaction Questionnaire (PSQ): this WPBA allows for patient feedback and can be thought of as an assessment of your work questionnaire. It is recommended to be carried out in the middle of ST3 and requires 34 patient responses.
Reponses can be recorded electronically or by paper format. If it is paper format, reception staff should hand them out and receive them. Trainees should not be involved in this process. The results from the paper feedback should be uploaded by a member of the administration team in the surgery.
As with the MSF, trainees are required to fill in a self-assessment before receiving patient feedback. Once 34 responses are recorded, trainees can close the survey which will allow their educational supervisor to see the results and schedule a feedback session.
The PSQ should be repeated at a later date to demonstrate progress if the results are significantly lower than their peers.
Quality Improvement Activity (QIA): these are any activity relating to your personal work field that has the scope to improve. QIAs also include reflection on the outcome of the QIA and any changes made (if any).
Quality Improvement Project (QIP): these are done in the primary care setting in ST1 or ST2. QIPs should have clear aims with measurable outcomes.
Trainees are advised to keep them simple and precise to the change you are trying to achieve. QIPs are designed to increase patient safety or their standard of care.
Prescribing Assessments: this is a formative exercise where trainees look back on their last 50 prescriptions and map them against potential errors. Supervisors are required to review 20 of those, adding other potential errors. Reflection and the assessment form can be completed after this.
Care Assessment Tool (CAT): this is a term that encompasses many WPBAs such as CbD, random case reviews, leadership activities, prescribing assessment follow up and referral review.
Random case reviews: can be done in multiple ways. Some supervisors may choose to sit in on a trainee’s surgery to get an overview of their performance. Some may pick a couple of cases and analyse them with more depth.
Prescribing assessment follow up: this occurs after the prescribing assessment and focusses on the areas/prescribing scenarios that trainees identified as requiring extra development. This is a follow up opportunity for you and your supervisor to ensure that you are now competent in those areas.
Referral Review: trainees must assemble their referrals and their corresponding medical letters for their supervisor. This is both a developmental assessment and a strength based assessment. Supervisors will comment on areas of appropriate patient care and will provide constrictive feedback on cases where an urgent referral may not have been needed.
Consultation Observation Tool (COT): these can be considered the mini-CEX version in primary practice. Trainees can choose between recording their consultations or having it completed in person with their supervisor. Telephone consultations can be used (an Audio-COT assessment form is available).
It should be noted that the RCA (Recorded Consultation Assessment) also requires 13 recorded consultations but trainees cannot use one consultation for both assessments.
The WPBAs above are one of the clinical assessment tools used in postgraduate GP training. It is worthwhile for trainees to familiarise themselves with the different requirements of each WPBAs.
MRCGP: Recorded Consultation Assessment (RCA) [Internet]. Rcgp.org.uk. 2021 [cited 5 October 2021]. Available from: https://www.rcgp.org.uk/gp-training-and-exams/mrcgp-exam/mrcgp-recorded-consultation-assessment.aspx
WPBA capabilities with IPUs [Internet]. Rcgp.org.uk. 2021 [cited 5 October 2021]. Available from: https://www.rcgp.org.uk/training-exams/training/workplace-based-assessment-wpba/capability-framework.aspx
Who Can Complete Workplace Based Assessments [Internet]. RCGP; 2021 [cited 5 October 2021]. Available from: https://www.rcgp.org.uk/-/media/Files/GP-training-and-exams/WPBA/Guidance-on-who-can-complete-WPBA-assessments.ashx?la=en