Rethinking assessment: The role of WBA in supporting CBD
Under Competence by Design (CBD), workplace-based assessment (WBA) is the process through which clinician teachers provide timely and formative feedback in the clinical setting to promote resident learning. WBAs promote a supportive learning culture for residents through regular, documented observation and coaching.
Here are three ways that WBA is transforming teaching and learning to help residents excel in 21st century health care.
1. Change the language to change the culture
Language can be a powerful thing, and the term assessment can be an intimidating word for many learners. As part of CBD, the Royal College is encouraging the use of language that promotes a culture of constructive feedback and documented observation.
“For some learners, the word ‘assessment’ is scary and brings negative memories and associations. For these learners, using the word ‘observation’ instead of ‘assessment’, helps them to understand that the primary focus of someone watching and documenting their performance is to help them improve, as opposed to passing or failing them," explains Nancy Dudek, MD, MEd, FRCPC, one of the Royal College’s Clinician Educators who is focusing on WBA.
As your program shifts to CBD, consider your context and audience first, and then choose the language that will resonate best. The following terms can be used interchangeably, but often have a different impact: workplace-based assessment, work-based assessment, and documented observation.
2. Coaching in the moment: Embracing a growth mindset
Regular and timely conversations between a learner and an observer are a critical element of WBA. Frontline clinical teachers are encouraged to observe trainees in practice and provide written and verbal feedback designed to promote learner growth.
“We are seeing a culture change where we are moving away from assessment in its usual manner of a ‘decision’, but rather ‘assessment for learning’ where there is an opportunity for coaching and really allowing for that growth mindset’,” explains Farhan Bhanji, MD, MHPE, FRCPC, a CanMEDS Clinician Educator and the Associate Director of Assessment at the Royal College.
Coaching in the Moment requires clinicians to establish rapport and set expectations with their residents, observe the residents doing their daily work, provide coaching feedback, and record the encounter. Frequent observation is a key ingredient in resident learning and assessment.
This model, known as “coaching in the moment”, follows the RX-OCR step-by-step process: Rapport, EXpectations, Observe, Coach, Record. In RX-OCR, feedback is given to the resident and then documented in various WBA tools chosen by individual specialty committees and programs. These individual WBAs are aggregated and ultimately paint a picture of a trainee’s performance and progress over time. Competence committees study these overall pictures to make holistic judgements on the progress of a resident.
3. Aligning WBAs with individual programs
As is the case with EPAs and Milestones, individual specialty committees and programs are able to tailor their individual assessment programs. There are four CBD observation templates designed by the Royal College, which help establish a common language of assessment and prompt conversations about the essential ingredients of competence, as well as the factors contributing to entrustment decisions. Some programs/disciplines may have other valid assessment tools that they will choose to include in their assessment program. We support and encourage their continued use, even after a program transitions to CBD.