Workplace-based assessment: measuring and shaping clinical learning.

Assessment of clinical competence is a challenge. It should not only help us in measuring performance but also in improving performance. Traditional assessment has many flaws, mainly related to snapshot observations, artificial settings and lack of opportunity to improve performance. Workplace-based assessment (WPBA) refers to direct observation of performance at the workplace. It builds on the ways people learn at the workplace. The key feature of all tools used for WPBA is direct observation of trainee performance at the workplace followed by provision of feedback based on that observation. This makes such an assessment valid. Though most of the tools use subjective observations, the assessment is reliable due to use of multiple encounters being assessed by multiple assessors in multiple settings. In addition, WPBA has high utility in terms of its educational impact. WPBA involves sampling of the clinical work using logbooks or encounter cards and direct observation of performance of clinical competence and procedural skills. These are supplemented by assessment by various people who can provide authentic information about a trainee's work habits. The encounters and ratings are documented in a portfolio, which allows a longitudinal record of trainees' progress. Experience suggests that WPBA has the potential to shape clinical learning and steer it towards desirable learning outcomes. Most of the tools used for WPBA can be applied in the Indian context.