'It's the conversation they'll learn from': improving assessments for GP Specialist Trainees in hospital posts.

Background: Workplace-based assessment (WPBA) is now a central feature of postgraduate training and required for Membership of the Royal College of General Practitioners (MRCGP). A previous study established that many GP trainees question the validity and usefulness of WPBA during hospital posts. Many of the factors identified, for example superficial feedback, leniency and a 'tick box' culture, suggested that assessors may hold some of the answers about how to improve the system.

Aim: To explore the views of hospital-based assessors across a range of specialities about how WPBA works with GP trainees.

Design: A qualitative approach was taken to explore views in-depth by means of one-to-one interviews.

Setting: Three training locations within Severn Deanery.

Methods: Consultants were sampled purposively and 15 took part in semi-structured interviews between November 2010 and May 2011. Interviews were recorded and transcribed, and analysed using a thematic framework approach.

Results: While WPBA provides a mandate for giving feedback to trainees, assessors say that honesty can be lacking and they find giving negative feedback hard to handle. Nonetheless, the verbal and qualitative elements of the process are valued and bring a crucial depth to the process. Assessors are not familiar with GP training requirements and would benefit from more contact with GP leads and supervisors.

Conclusions: The views of assessors in this study echo those of the GP trainees in the earlier study, emphasising areas where action should be taken to strengthen the system of assessment so that WPBA improves the performance of doctors. The professional conversation and scope for free text comments hold the most potential for adding value to the process. Sharing information across hospital and GP supervisors could also help recognise high-achieving trainees, not just those who are struggling. This would help to address a central criticism that WPBA is focused on a minimum standard of competence rather than excellence, thus losing an important motivation among trainees and weakening the effect of WPBA in helping to deliver better doctors.