Workplace Based Assessments (WPBA)

The Workplace Based Assessments (WPBA) will inform the final recommendation by the local scheme lead at HEE to NHS England about the doctor’s clinical ability, and this will inform NHS England’s decision regarding inclusion on the Medical Performers List (MPL).

Gathering information for the WPBA needs to be planned from the outset, and discussing the contents of the end of placement report would be a useful topic for discussion between the doctor and their supervisor in the first few days of the placement.

The doctor is required to demonstrate their competence under a range of headings, including the following:

1. Clinical expertise
   1. History and examination
   2. Clinical management
   3. Investigations
   4. Urgent care
2. Communication and teamwork
   1. Consultation and communication skills
   2. Teamworking skills
3. Professionalism
   1. Professional integrity
   2. Primary care administration and record keeping
   3. Understanding NHS systems and community orientation
   4. Organisation and planning
   5. Learning and development

The clinical supervisor (CS), or educational supervisor (ES) if they are undertaking both roles, is asked to carry out workplace-based assessments and record these on FourteenFish, as well as completing interim competence reviews each month or more frequently as required in the doctor’s FourteenFish portfolio. This is so that they can provide evidence of the doctor making progress towards demonstrating their competence.

Multi-source feedback (MSF)

MSF is required once during the placement, unless the placement is of only one month. In some cases the local HEE lead will request that the MSF be repeated at the end of the placement (e.g. if an MSF was carried out part-way through the placement and the findings were unsatisfactory).

The FourteenFish website has a suitable tool embedded in the e-portfolio, and either this or another approved tool should be used, so that the doctor can submit this for their appraisal and revalidation.

When doctors create their survey, it is recommended that they invite at least 18 colleagues with good range of professionals, with 50% non-clinical. 15 responses will be needed to satisfy requirements of most areas of NHS England and designated bodies. If doctors are not sure of the expectations for their designated body or if they have trouble collecting 15 responses, it is recommended that they check with their local appraisal service and, if necessary, speak to the survey provider.

Patient satisfaction questionnaire (PSQ)

PSQ is required once during the placement, unless the placement is of only one month. Again, a suitable tool is available on FourteenFish, but if this is not used another approved tool should be used, so that the doctor can submit this for their appraisal and revalidation.

FourteenFish operate their surveys according to the same standard as the GMC, so the minimum number of responses is 34.

Consultation observation tool (COT)

Several of the criteria relate to clinical and consultation skills and so this is one of the most useful tools. There is the facility to record the COT scoring on FourteenFish. Although no minimum number can be stipulated, as there is no clear evidence from the literature that can be used to define a minimum number, it is recognised that good performance in one case doesn’t necessarily predict a good performance in another case (Elstein and Shulman 1978), and so it is expected that the ES will observe and assess several consultations using this tool.

It is also known that there are advantages to these assessments being carried out by different supervisors in order to “triangulate” the overall assessment (Crossley et al, 2011). There will be a particular need to assess their consulting skills, using the COT, early in the placement so that any difficulties in this area can be identified early.

For further information on the COT, visit the Bradford VTS website, or visit the Royal College of General Practitioners (RCGP) website for their WPBA tools.

Case-based discussion (CBD)

CBD can be useful for exploring the doctor’s decision-making for clinical issues, and are also useful for assessing the doctor against the various criteria for professionalism. Once again, there is the facility to record this assessment on FourteenFish.

In the interim competence reviews, for each of the areas of competence, the ES is asked to make a judgement as to whether the doctor is “Below expectation”, “Needs further development”, or “Competent”. There are word descriptors provided to give examples of behaviours that would constitute different levels of performance, although these are not intended to be exhaustive.

It is important to identify doctors who are failing to make adequate progress, and whom should therefore be discussed at an early stage with the local HEE programme lead.

FourteenFish ePortfolio

The FourteenFish includes an end of placement report which should be completed about two weeks before the placement is scheduled to end. The e-portfolio will collate all of the judgements made previously in the interim reviews.

It is important that supervisors only complete the final overall recommendation that the doctor is competent when they have confirmed competence in all the competencies in the report.

The completed report should be passed to the local HEE programme lead for sign-off before submission to NHS England.