All Educational Supervisors (i.e. all Consultant Psychiatrists) in our wee corner of the world were summoned to learn about Workplace Based Assessments, last week. Although it kicked off in 2005 with PMETB (the Postgraduate Medical Education and Training Board) the behemoth of change rumbles over us, crushing past success and introducing change. Because, erm . . . change is good. I'm told. So it goes.
"Roll up, roll up, come see the greatest show on Earth!" We sat dutifully whilst clever folk told us about Why It Had To Be and flirted with selling the whole thing to us. No matter what magic and words were woven, this trick didn't work. To say the reception was "frosty" is rather like saying the void of deep space is "a tad chilly."
"See, see how friendly and enticing this is! Gasp at the splendor of it all! Why, it's even in colour, don't you know!" We then were directed (erm, I think they called it something more pleasing like instructed, though, or mentored, p'raps) in the use the plethora of Workplace Based Assessment forms that our otherwise sensible College is foisting 'pon us.
"Watch them perform! Come, come see the clowns!" Oodles of Consultants, who've all been training juinor doctors for many years, watched. All had just been indoctrinated (erm, mentored, facilitated, coached, did they say?) in Workplace Based Assessment then immediately we were given videos of trainee/trainer interviews to rate. Excellent, then, cutting to the chase. Let's just crack on and do that then, so we can get our trainees through the myriad of hoops they've now to jump through. "Jumping through hoops, high how can they go? Oooh, watch them skip and dance! What a performance, what a show!"
Our ringleader whipped us in to shape, working us in a score of small groups, scoring the performance of the trainees in the videos. We get through a few videos, a few different mini-ACE and Case-based Discussion. "Did they frolic, cavort and entertain? Did they leap to the hoops, only to fall? What scores, what ratings one and all?" We compared scores. A score of 4 is a pass, meeting the necessary standard. 5 or 6 is great (above standard and mastery). 1 to 3 is a fail, below standard. In one video we all watched the room scored the trainee from 1 to 5. Some failed the trainee as the worst ever, some passed her as above standard. This pattern unfolded itself again and again. We all watched the same video, had the same training and used the same scales at the same time (and discussed it in small groups so no one voice generated extremes). Yet there was huge variation in whether the candidate would pass (well) or fail (catastrophically). Not just a few voices in each camp, either, with most in the middle . . . there really was huge spread. So it goes.
"Ah, what mirth, what merry japes, 't is but practice, after all" And, in point of fact, it's the clinical practice of the whole next generation of doctors that's being flippantly fiddled with. Doctors who will be treating me. Treating my kith and kin. So it goes.
I've tried to register with the Healthcare Assessment and Training (HcAT) website who say they've sent me details to log on, but they lie. So since all forms are online I can't do any assessments with my trainee. None what so ever. So it goes.
Am I the only one who feels that form and theatre and checklists wholly eclipses merit and content? We live in interesting times. Junior doctor training has been modernised. So it goes.