Implementing workplace-based assessment across the medical specialties in the United Kingdom.
OBJECTIVE
To evaluate the reliability and feasibility of assessing the performance of medical specialist registrars (SpRs) using three methods: the mini-clinical evaluation exercise (mini-CEX), directly observed procedural skills (DOPS) and multi-source feedback (MSF) to help inform annual decisions about the outcome of SpR training.


METHODS
We conducted a feasibility study and generalisability analysis based on the application of these assessment methods and the resulting data. A total of 230 SpRs (from 17 specialties) in 58 UK hospitals took part from 2003 to 2004. Main outcome measures included: time taken for each assessment, and variance component analysis of mean scores and derivation of 95% confidence intervals for individual doctors' scores based on the standard error of measurement. Responses to direct questions on questionnaires were analysed, as were the themes emerging from open-comment responses.


RESULTS
The methods can provide reliable scores with appropriate sampling. In our sample, all trainees who completed the number of assessments recommended by the Royal Colleges of Physicians had scores that were 95% certain to be better than unsatisfactory. The mean time taken to complete the mini-CEX (including feedback) was 25 minutes. The DOPS required the duration of the procedure being assessed plus an additional third of this time for feedback. The mean time required for each rater to complete his or her MSF form was 6 minutes.


CONCLUSIONS
This is the first attempt to evaluate the use of comprehensive workplace assessment across the medical specialties in the UK. The methods are feasible to conduct and can make reliable distinctions between doctors' performances. With adaptation, they may be appropriate for assessing the workplace performance of other grades and specialties of doctor. This may be helpful in informing foundation assessment.
Wilkinson
James R
JR
Royal College of Physicians, London, UK. stigassessment@mac.com
Crossley
James G M
JG
Wragg
Andrew
A
Mills
Peter
P
Cowan
George
G
Wade
Winnie
W
D000704:Analysis of Variance; D002983:Clinical Competence / Q000592:standards*; D004650:Employee Performance Appraisal / Q000379:methods*; D005240:Feasibility Studies; D005246:Feedback; D008505:Medical Staff, Hospital / Q000592:standards*; D008511:Medicine; D013038:Specialization; D006113:United Kingdom; D017132:Workplace