Workplace-Based Assessments (WPBAs) in psychiatric training

Introduction

The Royal College describes Workplace-Based Assessments (WPBAs) in the following way:

  1. They are formative and serve as the basis for feedback and educational planning.
  2. WPBAs are summative in the sense that they contribute to the Annual Review of Competence Progression (ARCP).
  3. Completing a specified number of WPBAs are required to be allowed to take the MRCPsych examination, and are therefore essential for career progression.

Further, WPBAs should provide: feedback on both strengths and weaknesses; identification of development needs; and a framework in which trainees in difficulty can be both identified and helped.

The College has information on WPBAs on their website and it is worthwhile mastering the principles and practice of this relatively new form of assessment.

Type of Assessment

There are a variety of tools and assessments available (See Table 1 below). It is worthwhile noting that not all are compulsory. However, each trainee must complete a set number of ACEs, mini-ACEs, CBDs, and mini-PATs each year and these must be completed online. The other forms can be completed as paper copies and kept in your portfolio.

Table 1. Types of WPBA for Psychiatric Trainees. Mandatory ones must be completed online and are highlighted below.
Name Description
Number to be completed each year
Assessment of Clinical Expertise (ACE) The assessor observes a whole patient encounter, from start to finish, rating interview technique, mental state examination, and management skills.
2-3 (See Table 2)
Mini-Assessed Clinical Encounter (mini-ACE) The assessor rates a specific section of a clinical interview, for example History of Presenting Problem, Giving Feedback, Discussing treatment, etc.
4
Case-Based Discussion (CBD)

You choose two sets of case notes for patients that you have seen. Your assessor chooses one and the notes act as a focus for discussion of clinical decision-making. It also allows assessment of clinical knowledge.

2
Mini-Peer Assessment Tool (mini-PAT)

Allows peers and colleagues to rate a variety of skills including clinical skills, team-working, and attitudes.

2
Case Presentation (CP)

May be used when a case is presented. It looks at a variety of domains including presentation skills and appraisal of evidence.

1
Journal Club Presentation (JCP)

When journal articles are presented, this tool allows analytical skills and critical appraisal to be assessed.

1
Directly Observed Procedural Skills (DOPS)

More likely to be used in other specialties, it can be used to rate skills such as administering ECT.

As the opportunity arises
Assessment of Teaching (AoT)

As the name suggests, the tool can be used when you give a presentation or lead a tutorial, and assesses teaching skills.

As the opportunity arises

 

Table 2. Numbers of WPBAs required over course of ST1-3 training

Year of training

ACE

Mini-ACE

CBD

ST1
2
4
2
ST2
3
4
2
ST3
3
4
2

Lists of Competencies

It is worth familiarising yourself with the competencies expected of you at each stage of your training. Indeed, the College says that:

"This list of competencies is a key document. You must familiarise yourselves with this in order to manage your training with the help of your educational supervisor."

The specific competencies being assessed in each WPBA are shown below in Table 3.

Table 3.Competencies being assessed in each WPBA.
Assessment Area Description for a satisfactory trainee
Assessment of Clinical Expertise (ACE/ Mini-ACE ) History taking Facilitates patient’s telling of the story, effectively uses appropriate questions to obtain accurate, adequate information, responds appropriately to verbal and non-verbal cues.
Communication skills Explores the patient’s perspective, jargon-free, open and honest, empathic, explains treatment, including different options, the effects of treatment (likely benefits, common and serious side-effects), consequences of not treating and (in the case of procedures) details of what to expect during it. Agrees management plan/therapy with patient.
Clinical judgement Makes appropriate diagnosis and formulates a suitable management plan. Selectively orders/performs appropriate diagnostic studies, considers risks/benefits. Refers appropriately to other members of the MDT or other services.
Professionalism Shows respect, compassion, empathy, establishes trust; attends to patient’s needs of comfort, respect, confidentiality. Behaves in an ethical manner, awareness of relevant legal frameworks, including the Mental Health Act. Aware of limitations.
Organisation/efficiency Prioritises; is timely, succinct. Summarises.
Overall clinical care Demonstrates satisfactory clinical judgement, synthesis, caring, effectiveness, efficiency, appropriate use of resources, balances risks and benefits, awareness of own limitations.
Case-Based Discussion (CBD) Clinical record keeping The record is legible, signed, dated and appropriate to the problem, understandable in relation to, and in sequence with, other entries. The content of the record conforms to Trust and NICE guidelines (where such exist). It helps the next clinician who uses the record, to give effective and appropriate care.
Clinical assessment Can discuss how they understood the patient’s story and how through further inquiry appropriate to the patient’s problem and situation, the trainee was able to arrive at a concise formulation of the patient’s problem from which further action could be derived.
Risk assessment and management Can discuss the relevant information from the patient’s history and integrate this with knowledge of the key risks relevant to psychiatry to produce a concise risk assessment that would allow the development of a risk management plan. Appreciates the need for ongoing risk assessment and is aware of the place and the limitations of risk assessment tools and rating scales. The trainee is able to integrate NICE guidelines to the assessment. Can discuss the rationale for the risk management plan, including the reasons for using or not using powers under the Mental Health Act.
Treatment Can discuss the rationale for the treatment, including the risks and benefits. The trainee refers to appropriate guidelines (eg NICE) where they are available.
Investigation and referral Can discuss the rationale for any physical investigations ordered, for further enquiries that were conducted and for referral to other agencies or to members of the mental health MDT. Can demonstrate awareness of the ethical and legal frameworks for sharing information.
Follow-up and care planning Can discuss the rationale for the formulation of the management plan including follow up and referral to other agencies or members of the mental health MDT.
Professionalism Can discuss how the care of this patient, as recorded, demonstrated respect, compassion, empathy and established trust.
Can discuss how the patient’s need for respect and confidentiality were attended to. Can show how the record demonstrated an ethical approach and awareness of the legal framework. Has insight into own limitations.
Clinical reasoning Is able, with sound reasoning, to articulate the steps along the clinical pathway for each of the decisions that were taken.
Overall clinical care Can discuss own judgement, synthesis, caring, and effectiveness for this patient at the time that this record was made.
Case Presentation (CP) Assessment and Clinical examination A systematic and logical presentation. The Mental State Examination and physical assessment should be accurate and appropriate demonstrating core (psycho)pathology. May have some omissions and/or inaccuracies but must be a systematic and logical presentation.
Interpretation of Clinical Evidence An adequate differential diagnosis with no serious omissions. Could include a consideration of aetiology.
Use of Investigations Recognises need for many of the investigations required for informing diagnosis and management plan.
Presentation and Delivery Adequate communication but some problems such as inappropriately slow delivery or signs of anxiety. Adequate use of audio/visual aids.
Journal Club Presentation (JCP) Introducing the topic A clear, appropriately structured introduction covering all the main points.
Setting material in context The material is clearly set in relevant contexts of clinical work, other research etc.
Analysis and critique A careful, fairly thorough analysis and critique, well explained, with no significant omissions.
Presentation and Delivery An adequate presentation, reasonably well organized and clearly delivered with appropriate use of audio/visual aids.
Answering questions Generally gave clear and correct answers. Perhaps might have admitted not knowing some answers.
Educational value A good, worthwhile experience with clearly identified educational points.

Assessment Tools

The majority of trainees will have their assessments completed by their supervisor online using the HcAT (Healthcare Assessment & Training) System. However, paper versions of the tools exist and these are available below. The examples given are for ST1 but different versions exist for ST1, ST2-3, and ST4-5. All the WPBA forms are on the College website.

The relevance of being familiar with the areas on which you'll be assessed relates to how you prepare for assessment. For example, if you know that when you are having a lecture assessed you'll have 30% of your marks coming from your visual aids, then spending time on these is probably worthwhile. On the AoT, only 10% of marks comes from presentation and delivery, so you may be able to stumble and mumble through but still do okay if you've spent time on setting up the venue and making high-quality slides.

  1. Assessment of Clinical Expertise (ACE) ST1 level (PDF, 117Kb)
  2. Mini-Assessed Clinical Encounter (Mini-ACE) ST1 level (PDF, 117Kb)
  3. Mini-Peer Assessment Tool (mini-PAT) ST1 level (PDF, 146Kb)
  4. Case Based Discussion (CBD) ST1 level (PDF, 117Kb)
  5. Journal Club Presentation (JCP) All Levels (PDF, 111Kb)
  6. Assessment of Teaching (AoT) All Levels (PDF, 133Kb)

 

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References

Royal College of Psychiatrists (2007) Educational Supervisors’ Guide to Workplace Based Assessment and Appraisal of Psychiatric Trainees. London: Royal College of Psychiatrists.

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