Introduction

In the past three years widespread changes in post-graduate medical education in the United Kingdom have seen the uniform introduction of a range of workplace-based assessment tools. With the potential for on-the-job assessment, in a real setting, at any time of the day, these have rapidly gained importance in junior doctors training. However, some have questioned the evidence-base and validity for this form of assessment and many professionals required to assess junior doctors have not received any formal training in these assessment tools.

These new training tools consist of Directly Observes Procedural Skills (DOPS), Mini-Clinical Evaluation Exercises (mini-CEX), Case-Based Discussion (CbD) and Mini-Peer Assessment Tool (Mini ePAT).

Little research has assessed the opinions of end-users of these new assessment tools and the frequency and adequacy of training provided. Our hypothesis is that that few trained doctors acting as examiners perceive they have received adequate training in using these tools. We also hypothesise that many doctors question the use of these tools without evidence of validity in the training process.

This study aims to assess these views and present a current picture of views from those involved in examining and being examined by these new assessment tools.

Methods

A 10-item questionnaire consisting of free text and 5-point Likert scales was distributed to doctors working at a University Hospital and also a local District General Hospital to equally examine viewpoints. Results were collated by training grade and analysed with SPSS v 15.

Results

We received 98 completed questionnaires from a broad range of training grades and Consultants in a number of specialties. 52% of respondents were within the first two years of qualification and counted as trainees examined using the new assessment tools. 18% of respondents were Consultants and the remainder senior training grades. Both were involved in assessing junior doctors using the new assessment tools. Overall, 46% of respondents stated that they had not received training in any of these assessments and 43% were those senior doctors acting as examiners. Most medical staff believed DOPS and CbD to be useful part of training, with Mini-CEX and Mini-ePAT less likely to meet this perception. Overall, fewer professional thought these training tools benefited patient care. Doubt regarding the validity of these tools was expressed by all those participating. Interesting only 42% of those trainees being examined with these tools reported contemporaneous completion of the DOPS at the time procedures were being performed.

Conclusions

Amongst those charged with completing or assessing training requirements using the new work-placed based assessment tools in UK medical training, there is widespread concerns regarding lack of appropriate training and the validity of these methods. In the important area of procedural skills, few doctors are being assessed whilst directly observed performing these skills. These results indicate a need for adequate training and the establishment of an appropriate evidence base that must be communicated to trainees and assessors in order for this new method of workplace based training to be accepted.