Work-based Assessment and Co-production in Postgraduate Medical Training

Assessment has always been an essential component of postgraduate medical education and for many years focused predominantly on various types of examinations. While examinations of medical knowledge and more recently of clinical skills with standardized patients can assess learner capability in controlled settings and provide a level of assurance for the public, persistent and growing concerns regarding quality of care and patient safety worldwide has raised the importance and need for better work-based assessments. Work-based assessments, when done effectively, can more authentically capture the abilities of learners to actually provide safe, effective, patient-centered care. Furthermore, we have entered the era of interprofessional care where effective teamwork among multiple health care professionals is now paramount. Work-based assessment methods are now essential in an interprofessional healthcare world. To better prepare learners for these newer competencies and the ever-growing complexity of healthcare, many post-graduate medical education systems across the globe have turned to outcomes-based models of education, codified through competency frameworks. This commentary provides a brief overview on key methods of work-based assessment such as direct observation, multisource feedback, patient experience surveys and performance measures that are needed in a competency-based world that places a premium on educational and clinical outcomes. However, the full potential of work-based assessments will only be realized if post-graduate learners play an active role in their own assessment program. This will require a substantial culture change, and culture change only occurs through actions and changed behaviors. Co-production offers a practical and philosophical approach to engaging postgraduate learners to be active, intrinsically motivated agents for their own professional development, help to change learning culture and contribute to improving programmatic assessment in post-graduate training.