Incorporating assessor expertise to improve workplace-based assessment efficacy

Introduction: The failure to fail, and elevated grades in Workplace-Based Assessment (WBA) are well-documented phenomena and assessors play a major role in this process. The resulting WBA appears to be of little real use to any of the stakeholders involved. What do assessors think is the problem and what do they think would improve the situation for them? If we develop and trial WBA designed to suit the assessor and use their expertise, will this result in WBA that is more useful for everyone? Summary of Methodology: To explore this question, a search of the literature was first conducted aiming to summarise understanding of the way clinical assessors make decisions regarding WBA results. The following research was conducted in the context of undergraduate medical student training and assessment in the workplace, at the University of Wollongong, Australia. To begin with, clinician assessors of medical students were surveyed regarding their attitudes to failing a student, and other difficulties they face in WBA. Following analysis of the initial survey, qualitative interviews of 16 experienced clinician assessors were conducted to further tease out survey responses. Suggestions from both the literature and the assessors were then used to design a WBA system intended to respect both the assessors’ expertise, and their relationship with their student. The new WBA trial incorporated the following changes: all WBA by the student’s preceptor was formative and focussed on feedback for learning; summative WBA grades were awarded by senior supervisors and were not delivered face to face to the student; grades included a ‘conditional pass’ grade allowing assessors to pass the student but define a problem for early remediation; assessment of developing skills was graded using clinical language of entrustment; and preceptors were asked to write confidential narrative observations on student performance for supervisors. WBA student results were compared before and after the new