title: ARCADO - Adding random case analysis to direct observation in workplace-based formative assessment of general practice registrars.
abstract: BACKGROUND
  Workplace-based formative assessments using consultation observation are currently conducted during the Australian general practice training program. Assessment reliability is improved by using multiple assessment methods. The aim of this study was to explore experiences of general practice medical educator assessors and registrars (trainees) when adding random case analysis to direct observation (ARCADO) during formative workplace-based assessments.
  
  
  METHODS
  A sample of general practice medical educators and matched registrars were recruited. Following the ARCADO workplace assessment, semi-structured qualitative interviews were conducted. The data was analysed thematically.
  
  
  RESULTS
  Ten registrars and eight medical educators participated. Four major themes emerged - formative versus summative assessment; strengths (acceptability, flexibility, time efficiency, complementarity and authenticity); weaknesses (reduced observation and integrity risks); and contextual factors (variation in assessment content, assessment timing, registrar-medical educator relationship, medical educator's approach and registrar ability).
  
  
  CONCLUSIONS
  ARCADO is a well-accepted workplace-based formative assessment perceived by registrars and assessors to be valid and flexible. The use of ARCADO enabled complementary insights that would not have been achieved with direct observation alone. Whilst there are some contextual factors to be considered in its implementation, ARCADO appears to have utility as formative assessment and, subject to further evaluation, high-stakes assessment.
authors.affiliation: Beyond Medical Education, PO Box 3064, Bendigo, Victoria, 3550, Australia. drgingham@gmail.com.
authors.forename: Gerard
authors.initials: G
authors.lastname: Ingham
authors.affiliation: Beyond Medical Education, PO Box 3064, Bendigo, Victoria, 3550, Australia. jfry@beyondmedical.com.au.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Fry
authors.affiliation: GP Training Valley to Coast, Hunter Regional Mail Centre, PO Box 573, Newcastle, NSW, 2310, Australia. Simon.Morgan@gptvtc.com.au.
authors.forename: Simon
authors.initials: S
authors.lastname: Morgan
authors.affiliation: School of Rural Health, Monash University, PO Box 666, Bendigo, 3550, Victoria, Australia. Bernadette.Ward@monash.edu.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Ward
mesh_terms: D000328:Adult; D001315:Australia; D002983:Clinical Competence / Q000592:standards*; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D058006:General Practice / Q000193:education*; D006282:Health Personnel / Q000193:education*; D006801:Humans; D008297:Male; D000068616:Professionalism; D036301:Qualitative Research; D015203:Reproducibility of Results; D013192:Staff Development / Q000592:standards*; D017132:Workplace