Cheston Hannah, Graham David, Johnson Gavin, Woodland Philip
Medicine and Dentistry, Barts and The London School, London, UK.
Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, London, UK.
Postgrad Med J. 2022 Apr;98(1158):269-275. doi: 10.1136/postgradmedj-2020-137907. Epub 2021 Jan 15.
Workplace-based assessments (WPBAs) have become embedded in the training and assessment of UK medical trainees since the onset of the 21st century. When first introduced WPBA required a significant adjustment in both trainees' and educators' training behaviour, and was met with scepticism in some quarters. In this study, we aimed to evaluate how trainees' perceptions of WPBAs have evolved over a 10-year period, as experience with them has increased.
Two online questionnaires were constructed and distributed to UK trainees. The first was distributed in 2008, the second in 2018. Questions related to trainees' perception of WPBAs as a learning process and as a reflection of their competence.
All UK medical trainees were eligible to respond. In 2008, 482 trainees from 96 hospitals completed the questionnaire. In 2018, 356 trainees from 103 hospitals completed the questionnaire.
Data were analysed both quantitatively and qualitatively. A comparison between the numbers of each WPBA modality completed in 2008 and 2018 was assessed using chi-squared test. Comparisons of Likert scale values between 2008 and 2018 were assessed using unpaired t-test. Thematic analysis was carried out on free-text answers.
The number of forms completed per participant increased significantly from 2008 to 2018. In 2008, forms were most commonly completed immediately after a learning observation (34%). In 2018, forms were most commonly completed between 1 week and 1 month after observation (58%). In 2018, significantly fewer WPBAs were followed by an educational/beneficial discussion in comparison to 2008 data. The most common free-text theme in the 2008 data set was 'supervisor issues' whereas in 2018 the most commonly noted theme was 'limited educational benefit'.
Our study suggests trainees' perspectives of WPBAs have not changed in the 10 years since implementation. Trainees do not perceive WPBA as an accurate reflection of their competency but instead as a 'tick-box' bureaucratic exercise to enable career progression. Development of educator training and trainer and trainee job-planning is required to ensure that WPBAs are genuinely educational activities that offer an accurate reflection of trainees' medical competence.
自21世纪初以来，基于工作场所的评估（WPBA）已融入英国医学实习生的培训和评估之中。首次引入WPBA时，实习生和教育工作者的培训行为都需要进行重大调整，并且在某些方面遭到了质疑。在本研究中，我们旨在评估随着实习生对WPBA的经验增加，他们对WPBA的看法在10年期间是如何演变的。
构建了两份在线问卷并分发给英国的实习生。第一份问卷于2008年分发，第二份于2018年分发。问题涉及实习生对WPBA作为一种学习过程以及作为其能力反映的看法。
所有英国医学实习生均有资格作答。2008年，来自96家医院的482名实习生完成了问卷。2018年，来自103家医院的356名实习生完成了问卷。
对数据进行了定量和定性分析。使用卡方检验评估2008年和2018年完成的每种WPBA模式数量之间的比较。使用非配对t检验评估2008年和2018年李克特量表值之间的比较。对自由文本答案进行了主题分析。
从2008年到2018年，每位参与者完成的表格数量显著增加。2008年，表格最常在学习观察后立即完成（34%）。2018年，表格最常在观察后1周和1个月之间完成（58%）。与2008年的数据相比，2018年在WPBA之后进行教育性/有益讨论的情况明显减少。2008年数据集中最常见的自由文本主题是“导师问题”，而2018年最常提到的主题是“教育收益有限”。
我们的研究表明，自实施以来的10年里，实习生对WPBA的看法没有改变。实习生并不认为WPBA是对其能力的准确反映，而是将其视为一种为了职业发展而进行的“打勾”式官僚行为。需要开展教育工作者培训以及培训师和实习生的工作计划制定，以确保WPBA是真正的教育活动，能够准确反映实习生的医学能力。
