Department of Medicine for the Elderly, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
Med Educ. 2013 Mar;47(3):292-300. doi: 10.1111/medu.12113.
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.
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.
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).
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.
以学员为主体的工作场所评估（WPBA）在研究生医学培训中越来越多地被采用。众所周知，处于困境中的学员与同龄人表现不同；这些差异可能反映在他们对 WPBA 的使用上，并可能为评估困难学员的行为和评估提供新的见解。
从英国基础培训计划（FP）的 1900 名学员完成的 76115 次评估中提取数据。在这 1900 名学员中，有 95 名（5%）是处于困境的 FP 学员（FTiD）。我们使用多项逻辑回归分析了 WPBA 使用的各个方面，以比较 FTiD 与同龄人之间的行为差异。
在 48 个可能的比较中，只有两个（即按概率预期会发生的情况）显示出统计学上的显著差异：与同龄人相比，FTiD 更有可能在程序技能的直接观察中选择护士评估员（比值比[OR]7.05，95%置信区间[CI]1.23-40.43），并且更有可能在使用迷你同伴评估工具进行评估时选择非临床评估员（OR 30.44，95% CI 1.34-689.29）。
选择评估员的关键特征是熟悉度和获得积极评估的可能性。尽管这确实表明了需要进一步探讨的关联和趋势，但本分析并未表明 FTiD 与非困难学员在使用 WPBA 方面有任何不同。这些零结果很有趣，提出了前瞻性证实或反驳的假设，并为进一步研究挣扎学员如何在研究生培训中使用 WPBA 以指导 WPBA 在研究生培训中的未来实施提供了定性工作的假设。
