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• W1964161738 abstract "Editor,—In the recent editorial on anaesthesia and the competence revolution,1 Dr Greaves summarized clearly the problems involved in the assessment of doctors, and warns of the dangers inherent in following a vocational approach to the assessment of anaesthetists. However, as Dr Greaves writes, practical skills, behaviour and personal qualities are important requisites for an effective anaesthetist. So how best can we assess these aspects? It is clear that a “competency” approach, dividing the process of anaesthesia into a series of simple tasks, the performance of which is marked and collated, is not appropriate. Such an approach trivializes professional behaviour, with its complex underlying reasoning, and makes no effort to assess these deeper aspects. Yet it is clearly vital to examine performance in the workplace. The Standing Committee on Postgraduate Medical and Dental Education (SCOPME), whose role includes advising the Secretary of State on such matters, recognizes the need for service-based assessment. It suggests that such assessment should be a formal process with right of appeal, and should be fair, but not too bureaucratic or legalistic. Furthermore, it should be part of the learning process.2 Standards remain a problem. Using specific laid down criteria for each aspect of anaesthetic performance (criterion referencing) is one possibility. However, such an approach would be over complicated, requiring frequent revision of criteria used, and would not assess those deeper aspects of behaviour that we would wish to examine. Relating performance to that of others, regardless of the actual standards achieved (peer or norm referencing) is another, albeit unsatisfactory, approach. However, a third method, relating the standard of performance to the assessor’s expert understanding of the minimum required for safety (limen referencing) could provide the basis for a workplace-based assessment standard.2 Such an approach has been found to be useful and reliable.3 Although it is difficult to quantify the element of professional judgement involved, there is currently no better method of assessing performance of the whole task.4 Consensus opinion on standards is difficult to attain, but the main underlying issue must be one of ensuring the relative safety of the clinical practice of the trainee given that person’s stage of training and level of supervision. Consultant anaesthetists are well aware of what constitutes safe practice. By a continuing dialogue with the trainee, they are able to get a good idea of the underlying thought processes, attitudes, skills and knowledge, and provide feedback to the trainee. With appropriate safeguards, such judgmental elements within an array of assessments and assessors will strengthen rather than weaken the accuracy of the picture.4 Such safeguards might include full documentation, openness and right of appeal. It is helpful to avoid the use of graded assessments, because such an approach is highly subjective and lends a spurious objectivity to the assessment.5 To write, as Dr Greaves has in his concluding paragraph, that “until the time that research is done, measurements made in the workplace should not be used either to monitor the progress of trainees or make decisions in relation to their careers” is clearly wrong. After all, there is also a relative lack of quantitative research-based knowledge supporting the effectiveness of the medical education we provide, yet we would certainly not choose to stop providing any education on this basis. There is no single ideal assessment method, and it is unlikely that there ever will be. Each method used will have different advantages, disadvantages, reliability, validity and feasibility. A range of methods must therefore be used, in the knowledge of each one’s strengths and weaknesses. These will develop and become refined in the light of experience. The South Thames (E) Assessment Scheme is an example of one such scheme which is evolving in the full knowledge of the problems associated with workplace-based assessment, providing valuable feedback to trainee and trainer alike. The real danger lies in not performing assessments in the workplace. Without them, the Record of In-Training Assessment (RITA) system of Annual Review, upon which our whole system of specialist accreditation relies, becomes a worthless paper exercise." @default.
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• W1964161738 title "Anaesthesia and the competence revolution" @default.
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• W1964161738 doi "https://doi.org/10.1093/bja/80.4.562-a" @default.
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