Assessment in OMFS

1. Bob Woodwards SAC Chair, Oral and Maxillofacial Surgery Assessment in OMFS

2. What do we want? Objectivity Reproducibility Fairness Ability to spot underachievement early in training path

3. Competence-based curriculum Assessment framework Syllabus - explicit standards for common surgical and specialty-specific knowledge, clinical judgement, technical and operative skills and generic professional skills. ISCP

4. Assessment in the work place Assessment in simulated settings Assessment Does Shows how Knows how Knows Miller GE. Acad Med 1990;65 (Suppl.):S63–S67.

5. Producing the “Surgical Expert”

7. Key roles • The Programme Director • The Assigned Educational Supervisor • Clinical Supervisor • Trainers – in the multi-disciplinary team • The trainee

8. Trainee-led learning • Guided by the Assigned Educational Supervisor • Making meetings with the AES • Uploading assessments to portfolio • Completing the Learning Agreement • Triggering assessments, engaging assessors • Reading guidance notes • Taking up learning opportunities (planned or ad hoc) • Being prepared in good time for reviews

9. Principles of WPBA • Assessments for learning • The main purpose is to provide feedback • Start early in the placement and spread throughout year • Fits into normal practice • Repeated to show progress • Different settings, patients, different assessor improves • reliabilty • Trainees upload all assessments – good and less good

10. Feedback • Should cover: • How the trainee felt about the performance • Trainee’s strengths • Suggestions for development • Action plan for improvement

11. Steps in workplace assessment • Observation fits into normal practice • Provides verbal constructive feedback immediately after • Completion of form (if paper-based keep a copy) • Trainee uploads assessment into the portfolio • Assessor validates the assessment

12. ISCP WPBA methods • Mini-Clinical Evaluation Exercise (Mini-CEX) • Case-based Discussion (CBD) • Direct observation of procedural skills (Surgical DOPS) • Procedure-based Assessment (PBA) • Multi-source feedback (revised version of Mini-PAT coming soon)

13. Clinical Evaluation Exercise - Mini-CEX • Trainee-patient encounter e.g. A&E, clinic, ward • Observation + 10 mins for the form + feedback • History taking, physical exam, management, communication • At least 6 per year • Standard set is for the completion of that stage • Assessors are consultants, senior trainees, staff grades, other healthcare professionals + one by the AES

14. Case Based Discussion - CBD • Focussed discussion about a challenging case managed by the trainee • Based on trainee’s entries in patient’s notes • 30 minutes e.g. as part of mid-point appraisal • Ideal for evaluating reflective practice • 6 per year absolute minimum • Standard set is for the completion of that stage • Assessed by trainee’s AES or equivalent

15. Direct Observation of Procedural Skills • - Surgical DOPS • Covers all skills required to successfully perform a simple procedure • Ideally whenever a procedure is carried out • Observation + 10 mins for the form + feedback • Assess at least monthly • Assessors are consultants, senior trainees, staff grades, other healthcare professionals + one by the AES

16. Procedure Based Assessment - PBA • Covers all skills required to successfully perform a specialty index procedure • Ideally whenever a procedure is carried out • Observation + 10 minutes for the form + feedback • Assess at least monthly • Set at the standard of CCT • Assessor must be a consultant + one by AES

17. 11132 records from 2071 trainees global rating by level of training ST1 2.28 ST2 2.61 ST3 2.81 ST4 3.06 ST5 3.34 ST6-8 3.69 After J Foulkes 2009

18. Multi-source Feedback - MSF • Identifies problems of professional behaviour against GMP • 1 per year, can be repeated if necessary • Trainee self-assessment and 8-12 team ratings • Health and probity issues can be raised anonymously • Electronic feedback via the Assigned Educational Supervisor • AES has a face to face meeting with the trainee to present feedback and sign it off

19. Mini-PAT Feedback

20. Utility • Blueprinted against GMP • Studies - JCST evaluation, PBA study by Jonathan Beard • Valid - PBAs developed and trialled by SACs • Valid – Methods developed and validated in Foundation • Educational impact – quality of feedback and action plan, must be followed by reflection • Feasible - fits into normal practice • Reliable – different settings, patients and assessors • Acceptability – trainer/trainee engagement • Cost effective – time needed

21. Portfolio evidence • A range of different types of assessments in different settings • Assessors’ written comments • The mini-PAT report by the AES • The surgical logbook • Trainees’ presentations, audits, projects, reflections • Records of discussion with the trainee in appraisals • Learning Agreement, in particular AES’s report

22. AES’s end of placement report • Makes use of: • Evidence in the portfolio, especially assessors’ comments • Day to day observations of the trainee • A debriefing session with the clinical supervisor • Learning Agreement outcomes plus notes • Standards of GMP

23. Preparation for the ARCP • Deanery should provide at least 6 weeks’ notice to trainees • It is the trainee’s responsibility to provide a portfolio of complete evidence • Trainees should be aware that incomplete portfolios will result in outcome 5 • Ensure ARCP panels are thoroughly briefed

24. ARCP Evidence • Learning agreement, signing off syllabus topics • AES reports • WPBA in portfolio showing progress • Exams • Surgical logbook • Audit, research, projects

25. ARCP Outcomes Satisfactory Progress 1. Achieving progress and competences at the expected rate (clinical) Achieving progress and competences at the expected rate (academic) Unsatisfactory or insufficient evidence (trainee must meet with panel) 2. Development of specific competences required – additional training time not required 3. Inadequate progress by the trainee – additional training time required 4. Released from training programme with or without specified competences Released from academic programme 5. Incomplete evidence presented – additional training time may be required Recommendation for completion of training 6. Gained all required competences (clinical) Gained all required competences (academic)

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