As a trainee who has gone through Modernising Medical Careers (MMC) and completed numerous workplace-based assessments (WPBAs), including case-based discussions (CbDs), I read with interest the paper by Mynors-Wallis et al 1 on CbD as a tool for revalidation. Their conclusions were that consultants were positive about CbD but research on trainees showed resentment and mistrust. I suspect that the trainees’ views mentioned by the authors are not representative of current opinion, as the study does not acknowledge when the research was done, which was just after the MMC and 6 months after WPBAs were rolled out. This was the time of a seismic change in delivery of training, with both trainees and supervisors adjusting to the new landscape.
I carried out research focusing on the educational value of WPBAs 2 years after their introduction, using a questionnaire and trainee interviews (the results are unpublished, details available on request). The questionnaire was completed by 48% of trainees (41/86 specialist registrars years 1-5) and 41% of educational supervisors (35/86). This showed that 73% of trainees and 79% of supervisors felt that WPBAs had an educational value which was heavily dependent on feedback. Similarly, in the results obtained by Babu et al, 2 CbD was ranked the most useful by trainees, with no difference between higher and lower trainees. Trainees valued the discussion around the case, particularly on diagnosis and management, and supervisors felt that this gave better sense of trainees’ independent functioning. Both supervisors and trainees identified the importance of assessor training, and noted the tension between the formative and summative components, with trainees asking for more focus on feedback rather than scores. This has been previously identified by Malhotra et al, 3 with residents’ perceptions of the WPBA as an assessment v. educational tool and by the Postgraduate Medical Education and Training Board (PMETB) itself, 4 where they state that WPBAs must be used formatively and constructively lest they become no more than hoops to be jumped through, with the educational validity lost.
As a future consultant, I value the opportunity provided by WPBAs to discuss cases in a peer group as CbDs are the cornerstone of professional development and are useful for developing one's clinical practice. Given the concern raised by the PMETB about how WPBAs are used, I would urge the Royal College of Psychiatrists to learn these lessons and use CbD as a developmental ‘formative’ tool, with the focus on discussion, reflection and feedback and not let this become just another tick-box exercise.