title: Workplace-based assessments in Foundation Programme training: do trainees in difficulty use them differently?
abstract: BACKGROUND
  Trainee-led workplace-based assessment (WPBA) is increasingly used in postgraduate medical training. Trainees in difficulty are known to behave differently from their peers; these differences may be reflected in their use of WPBAs and may give new insights into the behaviour and assessment of struggling trainees.
  
  
  METHODS
  Data were extracted for 76 115 assessments, completed by 1900 UK Foundation Programme (FP) trainees. Of these 1900 trainees, 95 (5%) were FP trainees in difficulty (FTiDs). We analysed aspects of the use of WPBAs, using multiple logistic regressions, to compare the behaviours of FTiDs with those of their peers.
  
  
  RESULTS
  Of 48 possible comparisons, only two (i.e. the rate expected to occur by chance) showed statistically significant differences: relative to their peers, FTiDs were more likely to choose nurse assessors in direct observations of procedural skills (odds ratio [OR] 7.05, 95% confidence interval [CI] 1.23-40.43) and more likely to choose non-clinical assessors for assessments using the mini-peer assessment tool (OR 30.44, 95% CI 1.34-689.29).
  
  
  CONCLUSIONS
  Key features of assessor choice for FTiDs are familiarity and likelihood of receiving a positive assessment. This analysis has not demonstrated that FTiDs use WPBAs any differently from their peers who are not in difficulty, although it does suggest associations and trends that require further exploration. These null results are interesting and raise hypotheses for prospective confirmation or disproof, and for further qualitative work investigating how struggling trainees use WPBAs in order to guide the future implementation of WPBAs in postgraduate training.
authors: Department of Medicine for the Elderly, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK. colin.mitchell2@nhs.net
authors: Colin
authors: C
authors: Mitchell
authors: Sarita
authors: S
authors: Bhat
authors: Anne
authors: A
authors: Herbert
authors: Paul
authors: P
authors: Baker
mesh_terms: D001291:Attitude of Health Personnel; D002755:Choice Behavior; D002983:Clinical Competence / Q000592:standards; D004503:Education, Medical, Graduate; D004521:Educational Measurement / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D007400:Interprofessional Relations; D016015:Logistic Models; D008505:Medical Staff, Hospital / Q000193:education*; D016017:Odds Ratio; D010379:Peer Group; D017132:Workplace