Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Medicine, Western University, London, Ontario, Canada.
Med Educ. 2023 May;57(5):394-405. doi: 10.1111/medu.14960. Epub 2022 Nov 21.
Competency-based medical education (CBME) led to the widespread adoption of workplace-based assessment (WBA) with the promise of achieving assessment for learning. Despite this, studies have illustrated tensions between the summative and formative role of WBA which undermine learning goals. Models of workplace-based learning (WBL) provide insight, however, these models excluded WBA. This scoping review synthesizes the primary literature addressing the role of WBA to guide learning in postgraduate medical education, with the goal of identifying gaps to address in future studies.
The search was applied to OVID Medline, Web of Science, ERIC and CINAHL databases, articles up to September 2020 were included. Titles and abstracts were screened by two reviewers, followed by a full text review. Two members independently extracted and analysed quantitative and qualitative data using a descriptive-analytic technique rooted in Billett's four premises of WBL. Themes were synthesized and discussed until consensus.
All 33 papers focused on the perception of learning through WBA. The majority applied qualitative methodology (70%), and 12 studies (36%) made explicit reference to theory. Aligning with Billett's first premise, results reinforce that learning always occurs in the workplace. WBA helped guide learning goals and enhanced feedback frequency and specificity. Billett's remaining premises provided an important lens to understand how tensions that existed in WBL have been exacerbated with frequent WBA. As individuals engage in both work and WBA, they are slowly transforming the workplace. Culture and context frame individual experiences and the perceived authenticity of WBA. Finally, individuals will have different goals, and learn different things, from the same experience.
Analysing WBA literature through the lens of WBL theory allows us to reframe previously described tensions. We propose that future studies attend to learning theory, and demonstrate alignment with philosophical position, to advance our understanding of assessment-for-learning in the workplace.
以能力为基础的医学教育（CBME）推动了基于工作场所的评估（WBA）的广泛采用，承诺实现以学习为导向的评估。尽管如此，研究表明 WBA 的总结性和形成性角色之间存在紧张关系，这破坏了学习目标。然而，基于工作场所的学习（WBL）模型提供了深入的了解，但这些模型排除了 WBA。本范围综述综合了主要文献，以探讨 WBA 在研究生医学教育中指导学习的作用，旨在确定未来研究中需要解决的差距。
搜索应用于 OVID Medline、Web of Science、ERIC 和 CINAHL 数据库，纳入截至 2020 年 9 月的文章。两位评审员筛选标题和摘要，然后进行全文审查。两位成员独立使用根植于 Billett 的 WBL 四个前提的描述性分析技术提取和分析定量和定性数据。综合主题并进行讨论，直到达成共识。
所有 33 篇论文都集中在通过 WBA 感知学习。大多数采用定性方法（70%），12 项研究（36%）明确参考了理论。与 Billett 的第一个前提一致，结果强调学习总是在工作场所发生。WBA 有助于指导学习目标，并增强反馈的频率和针对性。Billett 的其余前提为理解 WBL 中存在的紧张关系如何随着频繁的 WBA 而加剧提供了重要视角。随着个人参与工作和 WBA，他们逐渐改变工作场所。文化和背景框架构成了个人经历和 WBA 的感知真实性。最后，同一个人会从相同的经历中获得不同的目标，并学到不同的东西。
通过 WBL 理论分析 WBA 文献使我们能够重新构建先前描述的紧张关系。我们建议未来的研究关注学习理论，并展示与哲学立场的一致性，以提高我们对工作场所中以学习为导向的评估的理解。
