Faculty Perceptions of Frame of Reference Training to Improve Workplace-Based Assessment.

Background: Workplace-based assessment (WBA) is a key assessment strategy in competency-based medical education. However, its full potential has not been actualized secondary to concerns with reliability, validity, and accuracy. Frame of reference training (FORT), a rater training technique that helps assessors distinguish between learner performance levels, can improve the accuracy and reliability of WBA, but the effect size is variable. Understanding FORT benefits and challenges help improve this rater training technique.

Objective: To explore faculty's perceptions of the benefits and challenges associated with FORT.

Methods: Subjects were internal medicine and family medicine physicians (n=41) who participated in a rater training intervention in 2018 consisting of in-person FORT followed by asynchronous online spaced learning. We assessed participants' perceptions of FORT in post-workshop focus groups and an end-of-study survey. Focus groups and survey free text responses were coded using thematic analysis.

Results: All subjects participated in 1 of 4 focus groups and completed the survey. Four benefits of FORT were identified: (1) opportunity to apply skills frameworks via deliberate practice; (2) demonstration of the importance of certain evidence-based clinical skills; (3) practice that improved the ability to discriminate between resident skill levels; and (4) highlighting the importance of direct observation and the dangers using proxy information in assessment. Challenges included time constraints and task repetitiveness.

Conclusions: Participants believe that FORT training serves multiple purposes, including helping them distinguish between learner skill levels while demonstrating the impact of evidence-based clinical skills and the importance of direct observation.