What is wrong with assessment in postgraduate training? Lessons from clinical practice and educational research.

Workplace-based assessment is more commonly given a lukewarm than a warm welcome by its prospective users. In this article, we summarise the workplace-based assessment literature as well as our own experiences with workplace-based assessment to derive lessons that can facilitate acceptance of workplace-based assessment in postgraduate specialty training. We propose to shift the emphasis in workplace-based assessment from assessment of trainee performance to the learning of trainees. Workplace-based assessment should focus on supporting supervisors in taking entrustment decisions by complementing their "gut feeling" with information from assessments and focus less on assessment and testability. One of the most stubborn problems with workplace-based assessment is the absence of observation of trainees and the lack of feedback based on observations. Non-standardised observations are used to organise feedback. To make these assessments meaningful for learning, it is essential that they are not perceived as summative by their users, that they provide narrative feedback for the learner and that there is a form of facilitation that helps to integrate the feedback in trainees' self-assessments.