Page updated: 30/04/08

 Knowledge Based Assessments and MRCP(UK)

Knowledge Based Assessment  (KBA) is centred around the Membership of the Royal Colleges of Physicians of the UK (MRCP[UK]) examination and to specialist examinations which must be taken and passed to the following timetable:  

• By exit from ST2 (ie completion of CMT or ACCS(M)): MRCP(UK) Part 1 written 

• By the end of ST3 (or the first year of specialty training):  MRCP(UK) Part 2 written & PACES 

• Before award of CCT, success in the specialty KBA must have been achieved. 

The importance of trainees attempting and passing the MRCP(UK) to this timetable cannot be over emphasised.   The MRCP(UK) forms a central plank in the assessment of all physician trainees.

Details of and the regulations pertaining to the MRCP(UK) may be found at www.mrcpuk.org with further information on Knowledge Based Assessment available at www.mrcpuk.org/kba

 Workplace Based Assessment (WPBA)

Trainees will be assessed in the workplace by a range of assessment methods and by a range of different (sometimes multi-professional) assessors.   The following paragraphs briefly describe the assessment methods to be used.    These methods will be used in different ways by different specialties.

• The mini clinical evaluation exercise (mini-CEX).    The mini-CEX is a workplace based method utilising direct observation of a trainee’s clinical skills during an everyday clinical encounter with a patient(s) on the ward or in clinic.   Six, primarily generic, skills are evaluated against a nine (six) point scale – including medical interviewing skills, communication and clinical judgment. 

• Directly Observed Procedural Skills (DOPS).   Similar to the mini-CEX, DOPS is a clinical encounter but evaluating the trainee’s competence in a particular procedure for example an endoscopy.

• Multi Source Feedback (MSF).   MSF is one of a number of acronyms (mini-PAT being a common alternative in use), for a process formerly called 360o assessment.   MSF uses a number of multidisciplinary ‘raters’ to score a trainee against a number of domains mostly concerned with attitudes and behaviours.  

• Acute Care Assessment Tool (ACAT).  ACAT is applicable to all grades from ST1 to their CCT.  ACAT is an observed ‘take’ measuring 8 domains for example clinical assessment, record keeping and handover. The ACAT is trainee led (choosing the take period and may be observed by an SpR/StR) and takes no more than 15 minutes.   This is a ‘formative’ assessment.  The form and instructions can be found here.

• Case based discussion (CbD).  CbD is a discussion generally in a reasonably formal setting centred on the trainee’s reflection on his/her patient notes.  The discussion will bring out key messages of trainees’ medical knowledge, case management, diagnostic skills and treatment planning etc.   CbD might be included as part of case presentations at department meetings. 

• Patient Satisfaction Questionnaire (PSQ). PSQ is a similar process to that of MSF but taking opinions from patients rather than colleague professionals.  PSQ does not yet exist for trainees although it has been piloted for consultants.

• Assessment of audit and a teaching assessment tool are possible methods currently under active development.

• Educational supervisor’s assessment is where the educational supervisor is responsible for completing a structured report – a synthesis of the evidence in the trainee’s learning portfolio summarising the WPBA, experience and additional activities.   It precedes the annual ARCP.   This process is described in the Gold Guide at Appendix 4.

Similarly to the KBA pilot study, the JCHMT undertook a successful pilot study into mini-CEX, MSF and DOPS the outcome of which may be found here.

Indicative frequency of workplace assessments .  For CMT and each specialty the frequency and timing of each WPBA has been set out in the relevant decision grid.  The pilot study into mini-CEX, DOPS and MSF, identified a minimum number of episodes to guarantee reproducibility in each case and should therefore be considered a minimum (for specialty training):

  *depends on the specialty requirements for procedure specific DOPS’

e-portfolio

See the e-portfolio section

Training Events for Assessors

The JRCPTB considers it essential that assessor training in the use of all WPBA is undertaken before assessors undertake the formal assessment of their trainees.   Training is widely available in deaneries and through the Education Dept at RCP (London)- tailored events have been run for various specialist groups and in a number of deaneries.

Video

Whilst not a substitute for formal training, the JCHMT produced a video illustrating the use of the three methods piloted and PSQ.   The video may be downloaded here or a CD-ROM copy may be obtained from ptb@jrcptb.org.uk.

You must have Media Player version 9 or above to view these Windows Media Video files.

• Part 1 - Introduction (7.5Mb wmv)
• Part 2 - mini Clinical Evaluation Exercise (mini-CEX) (19.9Mb wmv)
• Part 3 - Directly Observed Procedural Skills (DOPS) (4.9Mb wmv)
• Part 4 - 360 degree assessment (5.2Mb wmv)
• Part 5 - patient satisfaction questionnaire (3Mb wmv)
• Part 6 - conclusion (3.3Mb wmv)