Year

2020

Degree Name

Doctor of Philosophy

Department

School of Medicine

Abstract

Introduction: The failure to fail, and elevated grades in Workplace-Based Assessment (WBA) are well-documented phenomena and assessors play a major role in this process. The resulting WBA appears to be of little real use to any of the stakeholders involved. What do assessors think is the problem and what do they think would improve the situation for them? If we develop and trial WBA designed to suit the assessor and use their expertise, will this result in WBA that is more useful for everyone?

Summary of Methodology: To explore this question, a search of the literature was first conducted aiming to summarise understanding of the way clinical assessors make decisions regarding WBA results. The following research was conducted in the context of undergraduate medical student training and assessment in the workplace, at the University of Wollongong, Australia.

To begin with, clinician assessors of medical students were surveyed regarding their attitudes to failing a student, and other difficulties they face in WBA. Following analysis of the initial survey, qualitative interviews of 16 experienced clinician assessors were conducted to further tease out survey responses. Suggestions from both the literature and the assessors were then used to design a WBA system intended to respect both the assessors’ expertise, and their relationship with their student.

The new WBA trial incorporated the following changes: all WBA by the student’s preceptor was formative and focussed on feedback for learning; summative WBA grades were awarded by senior supervisors and were not delivered face to face to the student; grades included a ‘conditional pass’ grade allowing assessors to pass the student but define a problem for early remediation; assessment of developing skills was graded using clinical language of entrustment; and preceptors were asked to write confidential narrative observations on student performance for supervisors. WBA student results were compared before and after the new system was implemented. The opinions of all stakeholders (including students, assessors and the medical school) were also surveyed before and after the implementation of the new WBA for comparison.

Results: Assessors claimed to have little trouble identifying an underperforming student, but said that to fail a student face to face was ‘simply too hard’. Assessment within the mentor relationship was then described as further compounding the difficulty, rendering it virtually impossible.

The new WBA processes improved the hyper-inflated results. While the failure to fail remained a problem, there was good utilisation of the ‘conditional pass’ grade and preceptors felt their expertise was better utilised.

Conclusions: Assessors identified the failure to fail as the fault of the system, not the assessor. Assessors said they were able and willing to identify a student with problems and assist with remediation. They saw the mentor relationship as so important for learning that they felt WBA within this relationship should be used to enhance learning. Training institutions need to rethink the value of pass/fail decisions in WBA, especially when made by the mentor, and when results are delivered face to face to the student.

FoR codes (2020)

390110 Medicine, nursing and health curriculum and pedagogy, 390115 Work integrated learning (incl. internships), 390303 Higher education, 320224 Rural clinical health

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Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.