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REVIEW ARTICLE
Year : 2022  |  Volume : 15  |  Issue : 5  |  Page : 666-669  

Employing clinical work sampling tool for monitoring the clinical competence among medical students


1 Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India

Date of Submission21-Oct-2020
Date of Decision14-Apr-2021
Date of Acceptance04-May-2021
Date of Web Publication17-Jan-2022

Correspondence Address:
Saurabh RamBihariLal Shrivastava
Professor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_583_20

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  Abstract 


The ultimate goal of medical education across heterogeneous settings is to produce a competent medical graduate. It is important to remember that this vision cannot be complete without incorporating observation, assessment, and documentation of the students' performance while they are involved in patient care throughout the duration of the course. The present review was planned to explore the utility of clinical work sampling (CWS) tool in the process of assessment of competencies. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of 15 articles were selected based upon the suitability with the current review objectives and analyzed. To ensure that the students are directly observed while at work, the use of workplace-based assessment tools has been strongly advocated owing to the high reliability, validity, feasibility, and better educational impact. CWS is an effective teaching-learning and assessment tool that involves observation and simultaneous scoring of different domains of patient interaction and management. In conclusion, the assessment method of CWS is based on the direct observation of clinical performance of the students in the workplace. Owing to the high validity and reliability of the tool, it is the need of the hour to employ the same as a part of clinical teaching and assessment in heterogeneous settings.

Keywords: Clinical work sampling, medical education, workplace-based assessment


How to cite this article:
Shrivastava SR, Shrivastava PS. Employing clinical work sampling tool for monitoring the clinical competence among medical students. Med J DY Patil Vidyapeeth 2022;15:666-9

How to cite this URL:
Shrivastava SR, Shrivastava PS. Employing clinical work sampling tool for monitoring the clinical competence among medical students. Med J DY Patil Vidyapeeth [serial online] 2022 [cited 2022 Dec 6];15:666-9. Available from: https://www.mjdrdypv.org/text.asp?2022/15/5/666/335884




  Introduction Top


The ultimate goal of medical education across heterogeneous settings is to produce a competent medical graduate. It is important to remember that this vision cannot be complete without incorporating observation, assessment, and documentation of the students' performance while they are involved in patient care throughout the duration of the course.[1] This process of observation during the entire course not only helps the students to improve their knowledge and skills and monitor their clinical progression but also ensures that the institution fulfills their responsibility to produce a competent health-care professional who meets the expected standards at the community level.[1],[2],[3] The present review was planned to explore the utility of clinical work sampling (CWS) tool in the process of assessment of competencies, especially considering that only 2 studies have been done till date using the tool (PubMed search engine). Thus, considering the scope of the tool and the worth it adds to the process of teaching-learning and assessment, it was decided to perform the review on the current topic.


  Methods Top


An extensive search of all materials related to the topic was carried out in the PubMed search engine. Relevant research articles focusing on the use of CWS and workplace-based assessment (WPBA) in the field of medical training published in the period 2000–2021 were included in the review. A total of 17 studies similar to the current study objectives were identified initially, of which, 2 were excluded due to the unavailability of the complete version of the articles. Overall, 15 articles were selected based upon the suitability with the current review objectives and analyzed. Keywords used in the search include CWS and WPBA in the title alone only. Further, articles written in only English language were selected for inclusion in the current review. The collected information is presented under the following subheadings, namely WPBAs, CWS tool in medical education, and rationale for the use of CWS in medical training, approaches to perform assessment using CWS, challenges involved in implementation and suggested solutions, lessons from the field, implications for practice, and implications for research.


  Workplace-based Assessments Top


WPBAs have emerged as one of the most essential reforms in the field of assessment.[4] Considering the very fact that the tools listed under WPBA offer the advantage of assessing the highest level “Does” in the Miller's Pyramid of Skill Acquisition, it is a must that these tools become a routine part of the training.[5],[6] Further, we must realize that there is a difference between being competent and being able to replicate the skills in authentic (workplace) settings.[4],[5] In fact, our aim for medical training is to prepare the medical students to effectively perform in workplace settings, and thus, the use of these tools prepares them for the role; the medical students are expected to discharge.[4],[5],[6] Moreover, to ensure that the students are directly observed while at work, the use of WPBA tools has been strongly advocated owing to the high reliability, validity, feasibility, and better educational impact.[7],[8],[9]


  Clinical Work Sampling Tool in Medical Education Top


CWS is an effective teaching-learning and WPBA tool that involves observation and simultaneous scoring of different domains of patient interaction and management.[10] The best part of using this tool is that it does not require any special preparation and can be carried out right at the workplace in heterogeneous settings using the available resources on a daily basis.[10] This leads to another advantage that the assessment happens in real time and not on a retrospective basis and benefits the students to a significant extent owing to the feedback which is given by the teachers immediately after their performance.[10],[11]


  Rationale for Use of Clinical Work Sampling in Medical Training Top


It is a fact that many opportunities are there for the informal assessment of students during their daily interactions either in the ward or the outpatient department, and most of these clinical interactions are never reported.[10] These clinical opportunities can be captured by the CWS tool, which enables assessment of interactions without imposing an additional load on the teachers or other staffs.[10] To ensure the seamless employment of CWS in medical teaching, a series of assessment forms has been developed to capture the performance of students. After the completion of assessment, the teacher gives a constructive feedback and it is always ensured that students are assessed a multiple number of times by multiple assessors in multiple settings.[1],[10],[11]


  Approaches to Perform Assessment Using Clinical Work Sampling Top


These forms include admission rating form (assesses skills of students pertaining to obtaining history, clinical examination, communication skills, diagnostic ability, and management skills), ward rating forms (used to assess therapeutic approaches, consultation abilities, skills, interpersonal behaviors, etc.), multidisciplinary team rating form (which will be completed by nursing staffs and assesses all the above skills at least once in a month), and patients' rating form (filled by patients at the time of discharge and focuses on professionalism, health advocacy, etc.). The scoring is done using global rating scales and acts as a crucial approach to refine multiple skills of the students.[10],[11],[12],[13]


  Challenges Involved in Implementation and Suggested Solutions Top


The introduction of CWS in the existing medical curriculum can turn out to be a challenging task, especially with regard to convincing the teachers and the students to adopt the same in regular teaching and assessment.[12],[13],[14] Moreover, the very act of validating the various forms and the development of the global rating scales for all settings is a time-consuming process and requires dedicated involvement of the teachers. These challenges can be sorted out by organizing a sensitizing session for the teachers and the students and the merits of using CWS in clinical teaching. In the same session, teachers can also be exposed to the rating scale and the approach to be adopted for validation of the tool and the rubrics.[11],[15]


  Lessons from the Field Top


At Shri Sathya Sai Medical College and Research Institute, a constituent college of the Sri Balaji Vidyapeeth, Deemed-to-be-University, Puducherry, the Medical Education Unit is being involved in the periodic training of the faculty members from all clinical, pre, and paraclinical departments. The unit has been involved in the conduction of 4 revised basic course workshops and 2 curriculum implementation support programs, wherein specific attention has been given toward orienting the faculty members about the different WPBA tools. Further, the resource persons have also shared rating scales with the participants and given them live demonstration on how to go about the process of assessment.

However, considering the shortage of time in these National Medical Commission recommended sessions, the Medical Education Unit has been proactive and thereby organized 1-day workshops for all the faculty members (professional year-wise). In these 1-day workshops, apart from justifying the need to include WPBAs in training, the teachers have been given hands-on demo on to how to use these assessment tools. Feedbacks have been obtained from the participants about the sessions and based on their suggestions, the content and learning objectives of the subsequent workshops have been revised.


  Implications for Practice Top


Considering the rapid pace with which curriculum delivery in medical education is changing across the world, it becomes an indispensable need for the medical educators to adopt WPBA tools, including CWS tool. The process of introduction of CWS tool must start with sensitizing the faculty members about the same and the settings in which these tools can be used. During the training, the faculty members must be motivated to provide constructive feedback to the students about their performance, so that it can be improved in the future. This has to be followed by designing of the assessment tool, formulation of rubrics of milestones, and validating the tool using internal as well as external experts. The suggestions of Curriculum Committee and Medical Education Unit should also be given due consideration.

We cannot ignore the students in this entire planning and implementation phase, and accordingly, even they have to be sensitized about the CWS tool and what the tool adds to their training and clinical practice. Assessment using CWS tool should be done at least 6–8 times a year, preferably by different teachers under different settings. It is very essential that after assessment is done, students should be asked to reflect upon the entire process and what they liked and where their performance could have been better. In fact, under ideal settings, the assessor and the students should sit together and formulate a shared action plan for ensuring that improvement can be planned and tracked among the students.


  Implications for Research Top


The use of CWS tool in most of the educational settings is quite new, and thus, there is an ample scope for research activities. The research can start right from the settings wherein CWS tool can be used for the benefit of students. It will be a good research prospect to explore through a qualitative study employing focus group discussion method to understand the strengths and weaknesses of the tool. Further, the faculty members can also compare the effectiveness of CWS with other tools in improving the performance of the students, by giving exposure to students to both types of assessment methods.


  Conclusion Top


In conclusion, the assessment method of CWS is based on the direct observation of clinical performance of the students in the workplace. Owing to the high validity and reliability of the tool, it is the need of the hour to employ the same as a part of clinical teaching and assessment in heterogeneous settings.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Norcini J, Burch V. Workplace-based assessment as an educational tool: AMEE Guide No. 31. Med Teach 2007;29:855-71.  Back to cited text no. 1
    
2.
Hurst YK, Prescott-Clements L. Optimising workplace-based assessment. Clin Teach 2018;15:7-12.  Back to cited text no. 2
    
3.
Shrivastava SR, Shrivastava PS. Utilization of work place-based assessment tools in medical education: Potential challenges and solutions. Res Dev Med Educ 2020;9:8.  Back to cited text no. 3
    
4.
Kelleher M, Kinnear B, Wong SE, O'Toole J, Warm E. Linking workplace-based assessment to ACGME milestones: A comparison of mapping strategies in two specialties. Teach Learn Med 2020;32:194-203.  Back to cited text no. 4
    
5.
Primhak R, Gibson N. Workplace-based assessment: How to use case-based discussion as a formative assessment. Breathe (Sheff) 2019;15:163-6.  Back to cited text no. 5
    
6.
Miller A, Archer J. Impact of workplace based assessment on doctors' education and performance: A systematic review. BMJ 2010;341:c5064.  Back to cited text no. 6
    
7.
Govaerts M, van der Vleuten CP. Validity in work-based assessment: Expanding our horizons. Med Educ 2013;47:1164-74.  Back to cited text no. 7
    
8.
Fielding A, Mulquiney K, Canalese R, Tapley A, Holliday E, Ball J, et al. A general practice workplace-based assessment instrument: Content and construct validity. Med Teach 2020;42:204-12.  Back to cited text no. 8
    
9.
Yousuf Guraya S. Workplace-based assessment; Applications and educational impact. Malays J Med Sci 2015;22:5-10.  Back to cited text no. 9
    
10.
Turnbull J, MacFadyen J, Van Barneveld C, Norman G. Clinical work sampling a new approach to the problem of in-training evaluation. J Gen Intern Med 2000;15:556-61.  Back to cited text no. 10
    
11.
Finlay K, Norman GR, Stolberg H, Weaver B, Keane DR. In-training evaluation using hand-held computerized clinical work sampling strategies in radiology residency. Can Assoc Radiol J 2006;57:232-7.  Back to cited text no. 11
    
12.
Henry D, West DC. The clinical learning environment and workplace-based assessment: Frameworks, strategies, and implementation. Pediatr Clin North Am 2019;66:839-54.  Back to cited text no. 12
    
13.
Prins SH, Brøndt SG, Malling B. Implementation of workplace-based assessment in general practice. Educ Prim Care 2019;30:133-44.  Back to cited text no. 13
    
14.
Barrett A, Galvin R, Steinert Y, Scherpbier A, O'Shaughnessy A, Walsh G, et al. Profiling postgraduate workplace-based assessment implementation in Ireland: A retrospective cohort study. Springerplus 2016;5:133.  Back to cited text no. 14
    
15.
Rodgers V, Tripathi J, Lockeman K, Helou M, Lee C, Ryan MS. Implementation of a workplace-based assessment system to measure performance of the core entrustable professional activities in the pediatric clerkship. Acad Pediatr 2021;21:564-8.  Back to cited text no. 15
    




 

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