Monitoring and flagging performance
Frequent workplace-based assessments can help to identify registrars in need of additional educational support. Ongoing monitoring of registrars in difficulty is important to ensure they progress through training as expected.
Research indicates that early ‘flagging’ of a registrar as being in difficulty may be a predictor of positive exam performance, whilst flagging them late in training may reduce the effectiveness of remediation. Early detection and intervention minimises the risk of poor patient outcomes, avoids the need for resource-intensive formal remediation, and improves end-of-training summative assessment results. Early flagging also gives the registrar the opportunity to consider a career change.
WBA uses a traffic light system to flag a registrar’s performance as green, amber or red (Figure 6). It’s a useful way to establish the assessor’s level of concern about the registrar’s performance and the timeframe for action.
Registrars should be made aware of any concerns about their performance as early as possible so that they can tailor their learning to address these concerns.
Figure 6 - Levels of concern
Most registrars progress through training with green flags for all their assessments. For those who are flagged amber or red, the assessor provides feedback to the registrar at the time of the assessment and documents descriptive comments about how the performance elicited the flag.
If an amber or red flag is raised during an in-practice assessment by an external assessor, it is important that the assessor notify the supervisor so that appropriate and immediate action can be taken by the practice to address the issue. Additionally, a formal diagnostic process should be initiated by the registrar’s ME to identify the areas of concern. This may involve a discussion with the registrar and their supervisor, a review of data from previous WBAs, and review of previous flags. Sometimes the underlying problem may be a practice incident or a personal issue for the registrar. In the case of a red flag this process needs to be undertaken as soon as practical whereas with an amber flag this process can be undertaken within the fortnight.
If a red or amber flag has been raised, the registrar needs to be referred to the progression review committee using the PRC referral form. For an amber flag, the local team can decide if the registrar needs referral to the PRC for noting or discussion depending on the nature of the concern. The referral should include the areas of concern identified via the formal diagnostic process as well as recommendations for addressing those concerns.