Workplace-based assessment as an educational tool: AMEE Guide No. 31

Foundation for Advancement of International Medical Education and Research, Philadelphia 19104, USA.
Medical Teacher (Impact Factor: 2.05). 12/2007; 29(9):855-71. DOI: 10.1080/01421590701775453
Source: PubMed

ABSTRACT There has been concern that trainees are seldom observed, assessed, and given feedback during their workplace-based education. This has led to an increasing interest in a variety of formative assessment methods that require observation and offer the opportunity for feedback.
To review some of the literature on the efficacy and prevalence of formative feedback, describe the common formative assessment methods, characterize the nature of feedback, examine the effect of faculty development on its quality, and summarize the challenges still faced.
The research literature on formative assessment and feedback suggests that it is a powerful means for changing the behaviour of trainees. Several methods for assessing it have been developed and there is preliminary evidence of their reliability and validity. A variety of factors enhance the efficacy of workplace-based assessment including the provision of feedback that is consistent with the needs of the learner and focused on important aspects of the performance. Faculty plays a critical role and successful implementation requires that they receive training.
There is a need for formative assessment which offers trainees the opportunity for feedback. Several good methods exist and feedback has been shown to have a major influence on learning. The critical role of faculty is highlighted, as is the need for strategies to enhance their participation and training.

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    ABSTRACT: Background: Ward rounds represent a crucial activity in physicians’ daily practice in hospital. However, medical curricula lack adequate preparation for this task, and students report difficulties in performing and understanding ward rounds properly. We aimed at identifying differences in ward round scripts [1] between medical students and more experienced physicians. Differentiating between scenes (individual expectations regarding phases of a ward round), roles (participants) and scriptlets (activities) [2], we examined scriptlets with regard to 1. their content (medical, social, administrative, teaching and learning) [3] and 2. potential for knowledge construction (interactive, constructive, active, passive) [4]. Methods: We conducted standardized interviews with N=50 medical students and physicians at different expertise stages at a University Hospital using the structure formation technique [5] to map individuals’ scripts. Results: While scripts of individuals at different expertise stages showed a high similarity on a superficial level, in-depth analysis of scriptlets’ content and potential for knowledge construction revealed significant differences between groups: residents mainly mentioned activities bound to patient care, while students and more experienced physicians also perceived teaching and learning activities as typical for ward rounds (H(3)=7.128, p<0.01). In terms of activities’ potential for knowledge construction, stugroups (H(3)=18.25, p<0.001), whereas residents reported significantly more active activities than other groups (H(3)=9.71, p=0.02). Discussion: Our study detected expertise-related differences in scripts: residents did not perceive teaching and learning activities as typical for ward rounds. Given students’ deficits in understanding rounds as encounter for knowledge construction this conception is especially fatal, when preparing students for conducting rounds. It is not only necessary to support students to recognize activities at higher levels of knowledge construction and to understand themselves as active ward round participants. Moreover, there is a need to facilitating residents to understand ward rounds as encounter for teaching and learning. References 1. Schank RC. Dynamic memory revisited. Cambridge: Cambridge University Press; 2009. 2. Fischer F, Kollar I, Stegmann K, Wecker C. Toward a script theory of guidance in computer-supported collaborative learning. Educ Psychol. 2013;48(1):56-66. DOI: 10.1080/00461520.2012.748005 3. Walton JM. Steinert Y. Patterns of interaction during rounds: implications for work-based learning. Med Educ. 2010;44(6):550-8. DOI: 10.1111/j.1365-2923.2010.03626.x 4. Chi MT. Active-constructive-interactive: a conceptual framework for differentiating learning activities. Top Cogn Sci. 2009;1(1):73-105. DOI: 10.1111/j.1756-8765.2008.01005.x 5. Scheele B, Groeben N. Dialog-Konsens-Methoden zur Rekonstruktion Subjektiver Theorien: die Heidelberger Struktur-Lege-Technik (SLT), konsensuale Ziel-Mittel-Argumentation und kommunikative Flußdiagramm- Beschreibung von Handlungen. Tübingen: Francke Verlag; 1988. Please cite as: Beltermann E, Wessels I, Kollar I, Fischer MR. “I only stand around and look friendly” – Identifying deficits in medical students’ ward round scripts. In: 4th Research in Medical Education (RIME) Symposium 2015. München, 19.-21.03.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocS1A1. DOI: 10.3205/15rime06, URN: urn:nbn:de:0183-15rime065 Freely available from:
    4th Reseach in Medical Education Symposium 2015, Munich; 03/2015
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    ABSTRACT: Introduction: Despite their importance, ward rounds only attract little attention in medical education. As a consequence, medical students and junior physicians report difficulties in performing them properly [1], [2]. To overcome this lack, this study aims at identifying competencies and activities relevant for running a good ward round in internal medicine. In a second step, these competencies and activities are integrated into an Entrustable Professional Activity (EPA) [3] that can be used for teaching, and assessing individuals’ performance in both undergraduate and postgraduate medical education. Methods: We conducted an interview study with N=26 experienced physicians and nurses working at our University Hospital and belonging Academic Teaching Hospitals. The sample accounts for the broad range of hospitals. Through content analysis of interviews, competencies and activities relevant for ward rounds could be mapped. Results: Data analysis identified eight competencies as essential for performing ward rounds: communication with both patients and team, collaborative clinical reasoning, organizational competence, self-management, capacity for teamwork, problem solving, dealing with errors. Professionalism, empathy, patient management, clinical skills, teaching competence, technical knowledge and communication with relatives were also reported as necessary for conducting ward rounds. We could assign multiple activities to these competencies. Based on these results, we developed the EPA „Running a ward round in internal medicine“. Discussion: Data provide a sophisticated overview of competencies and belonging activities relevant for conducting good ward rounds. The EPA will be implemented and validated within a ward round training at our faculty that strives for preparing medical students already at an early stage for this crucial task of their future daily routine. References 1. Nikendei C, Kraus B, Schrauth M, Briem S, Jünger J. Ward rounds: how prepared are future doctors? Med Teach. 2008;30(1):88-91. DOI: 10.1080/01421590701753468 2. Norgaard K, Ringsted C, Dolmans, D. Validation of a checklist to assess ward round performance in internal medicine. Med Educ. 2004;38(7):700-707. DOI: 10.1111/j.1365-2929.2004.01840.x 3. Mulder H, Ten Cate O. Building a competency-based workplace curriculum around entrustable professional activities: The case of physician assistant training. Med Teach. 2010;32(10):e453–e459. DOI: 10.3109/0142159X.2010.513719 Please cite as: Wölfel T, Beltermann E, Lottspeich C, Vietz E, Fischer MR, Schmidmaier R. How to run a ward round in internal medicine – an Entrustable Professional Activity (EPA). In: 4th Research in Medical Education (RIME) Symposium 2015. München, 19.-21.03.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocS1A6. DOI: 10.3205/15rime11, URN: urn:nbn:de:0183-15rime117 Freely available from:
    4th Reseach in Medical Education Symposium 2015, Munich; 03/2015
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