A program of assessment refers to a series of progress assessment activities across the registrar’s journey. This program of assessment is for three purposes. These are:
- to judge readiness for key training progress points
- for early identification of progress issues and hence the need for educational interventions
- to support learning.
The key progress points are readiness:
- to enter general practice
- to train under indirect supervision in the general practice setting
- for sitting the RACGP Fellowship examinations
- for independent practice as a Fellow.
Early identification of progress issues is important and front ending of assessments helps to achieve this. Early intervention is known to be much more effective than late intervention.1 Assessment supports learning in three ways. It provides feedback on performance, it provides direction for future learning, and it provides the means for reflection.
The objectives of the program of assessment are to:2
- ensure that the registrar has the competencies required for the milestones of training
- monitor progress through the program from commencement to completion
- ensure that supervision is appropriately matched to the competency of the registrar
- provide guidance for learning and teaching
- identify performance concerns as early as possible to enable early interventions as needed
- promote the registrar’s ability to reflect on their performance and self-direct their learning
No single assessment can adequately assess the multiple components of being a GP. Multiple assessments using multiple methods are required to credibly assess the range of knowledge, skills and attitudes required of registrars as they work towards becoming an independent GP. The Progressive capability profile of the general practitioner details the range of capabilities and competencies required of registrars as they progress through training. Context can influence the assessment as can the characteristics of the assessor. Therefore, for the program of assessment to achieve the objectives of being valid, fair and reliable, assessments must:
- Occur routinely, start early and involve a range of different tools suitable to the context. The frequency of assessment may depend on the stage of training and the competency and learning needs of the registrar.
- Support learning through the inclusion of quality feedback as a two-way conversation that includes the registrar’s own assessment of their performance and results in reflection and planning for further learning.
- Be delivered by a range of different assessors who are competent in performing the assessment and in delivering feedback. External visitors to the practices for example, medical educators as well as supervisors within the practice will be involved in assessments. It is important to provide training and tools such as assessment rubrics and feedback to assessors about their assessments to achieve validity and reliability. Training also increases engagement in the assessments and quality of the feedback. Benchmarking data helps assessors in their judgements and helps registrars to interpret feedback provided.3
- Be part of a well-documented program that is clearly communicated to registrars and assessors. This includes details of:
This progressive program of assessment involves multiple measures over time to gauge a registrar’s knowledge, skills and attitudes. This requires efficient planning, clear processes and strong governance to ensure fairness in the making of higher stakes decisions. Those making high-stakes progress decisions should not be those performing the assessments.
The primary method of assessment should be work-based assessment as this assesses the ability to perform in the workplace. Work-based assessment methods include consultation observation, multi-source feedback, clinical case analysis, clinical audit and supervisor reports.4 It is an opportunity to assess professional attributes as well as knowledge and skills. Issues of professionalism are a common cause of patient dissatisfaction, adverse outcomes, progression difficulties, involuntary withdrawal from training and Ahpra notifications so should form part of a program of assessment.
To achieve the objective of providing guidance for individual learning, assessment needs to be combined with effective feedback conversations.5 Effective feedback is timely, regular, specific and constructive.5 It needs to engage the learner by addressing their perspective and identified needs. The credibility of the educator delivering the feedback is important. Supervisors who are judged to be credible as clinicians and educators and have a supportive relationship with their registrar are more able to engage in effective feedback interactions.6
Feedback helps to reinforce quality performance and address underperformance. It is essential for supporting registrars who require extra support to reach the expected standard. It is also important for high performers to receive quality feedback on a regular basis to achieve their full potential and to reinforce their performance. In addition, there are times when even those assessed as high performers will need assistance with their learning.7
The RACGP summative Fellowship assessments are not delivered by the training program. The program has a role however, in assisting registrars to complete these assessments by providing exam preparation support, including before the examinations or afterwards in the event of unsuccessful attempts. Registrars who face challenges with summative assessments may require additional support (see Standard 7).
Inability to reach the expected level of performance can occur for many reasons. These may relate to the individual, the learning and clinical environments, or the program. In managing underperformance, patient, registrar and practice safety needs to be considered.8
When there is an issue of unsatisfactorily progress, early identification and intervention is key to effectively addressing this and for reducing the risk of adverse outcomes.1 Learning intervention and remediation opportunities should be offered. There also needs to be accurate documentation of all issues identified, the interventions planned to address them, and any communication involved. Privacy needs to be protected in the way the documentation is stored and accessed. Throughout any remediation process, the wellbeing and health of the registrar must be supported. The program must have resources to support registrar wellbeing. These are discussed in Standard 6.