Workplace-based assessments in surgery: Are we heading in the wrong direction?

Dear Sir

Workplace-based assessments were intended to be used in a formative manner as tools to guide learning. Bindal et al. (2011) expressed concern that these assessments are being used in a summative way and this limits the educational value. They reported that finding available assessors and time pressures were major obstacles for successfully completing workplace-based assessments. These concerns were supported by Pereira and Dean (2009), who reported that only 6% of surgical trainees felt the inter-surgical curriculum project, which trainees use for workplace-based assessments, had a positive impact on training. Many trainees were filling in assessments in batches in one sitting, as a tick-box exercise further compromising the educational value.

I am pleased that the General Medical Council, UK, has responded to these concerns and has recommended that supervised learning events supersede workplace-based assessments. Supervised learning events should be used to help doctors progress by identifying strengths and areas for development. Performance descriptors are removed and outcomes of supervised learning events are not used as evidence in making formative assessments.

The national foundation programme for doctors has adopted these proposals, which seems to be a positive step in changing the cultural perception of workplace-based assessments. However, at odds to this, the joint committee on surgical training in the UK, this year, decided to increase the number of annual workplace-based assessments for surgical trainees to 40 per year. London deanery has taken this further, requiring a minimum number of 80 per year for their core trainees. It seems that this is a backward step. Bindal et al. (2011) have highlighted that trainees are already having difficulty in completing workplace-based assessments. In order to enhance educational quality, adequate time is needed for feedback, not an increase in quantity of assessments.