Workplace-based assessments of junior doctors: do scores predict training difficulties?

Area of Science:

• Medical Education
• Postgraduate Training Assessment
• Professional Competence Evaluation

Background:

• Workplace-based assessment (WPBA) is crucial for postgraduate medical training, serving as evidence of professional competence.
• Evaluating the efficacy of WPBA in identifying trainees facing difficulties is essential for targeted support.

Purpose of the Study:

• To assess if WPBA can distinguish UK Foundation Programme (FP) doctors with training difficulties.
• To determine WPBA's effectiveness as a surrogate marker for professional competence deficiencies.

Main Methods:

• Retrospective observational study of 1646 UK FP trainees (2005-2009).
• Analysis of WPBA scores (mini-CEX, CbD, DOPS, mini-PAT) from e-portfolio data.
• Comparison of scores between trainees identified as 'in difficulty' and their peers.

Main Results:

• Trainees in difficulty had significantly lower mean scores in mini-clinical evaluation exercise (mini-CEX) and case-based discussion (CbD).
• Mini-CEX (OR=0.54) and CbD (OR=0.39) scores were associated with training difficulties.
• WPBA scores had weak predictive value (AUC=0.64) for identifying trainees in difficulty; DOPS and mini-PAT showed no significant difference.

Conclusions:

• Lower mini-CEX and CbD scores correlate with training difficulties, but WPBA is not a valid screening method for identifying struggling trainees.
• WPBA serves best as a formative tool for supervision, feedback, and reflection, not for certifying competence.
• Assessment of professional competence should be holistic, integrating WPBA with other evaluation methods.