Context / probleemstelling of aanleiding
Probleemstelling (inclusief theoretische onderbouwing en onderzoeksvraag/vragen):
<b>Workplace-based assessment (WBA) has become central to evaluating medical trainees in authentic clinical settings, yet its implementation remains challenging due to concerns about subjectivity, bias, and the translation of theory into practice.<sup>1,2</sup> Most WBA studies focus on postgraduate contexts which differs from undergraduate education in the number of students and level of expected proficiency. Research on undergraduate training often examines components rather than entire systems and typically adopts a problem-solving perspective. This study addresses this gap by exploring medical students’ perceptions of WBA during clerkships, using Appreciative Inquiry to identify strengths and envision an ideal WBA system.</b>
Methode:
<b>We conducted six focus groups with in total 24 medical students in different clinical phases of their undergraduate program in Erasmus MC, representing diverse clerkship experiences. Guided by Appreciative Inquiry’s 4-D cycle (Discovery, Dream, Design, Destiny), group discussions explored positive experiences with current WBA practices. Topics included memorable assessment experiences, values and principles underpinning good assessment, desired changes to current assessment methods, and visions on ideal assessment systems. Data were analysed within a Grounded Theory framework through iterative coding, memos, diagrams, and team discussions to enhance rigour and reflexivity.</b>
Resultaten (en conclusie):
<b>We found three interrelated themes shaping students’ vision of the ideal WBA system. The first was <i>being seen as recognition of identity</i>, in which participants valued direct observation and personalised feedback that acknowledged their individuality and created a sense of belonging. Secondly, <i>growth as the core principle of assessment</i>, where a longitudinal relationship with a supervisor supported learning conversations about personal goals and professional identity formation. The third theme was <i>feeling safe to learn in an environment of shared responsibility</i>, which involved being treated as a legitimate member of the clinical team, having more standardised assessment procedures to enhance fairness perceptions, and ensuring assessor competence. Within these themes, different tensions emerged: valuing continuity with a single committed assessor versus incorporating multiple assessors to broaden input, favouring a pass/fail system to minimise competition versus seeking recognition of excellence, and striving for standardization versus embracing the subjectivity that is inherent to assessment.</b>
Discussie (beschouwing resultaten en conclusie in het kader van de theorie):
<b>Through the unique perspective offered by Appreciative Inquiry, we identified assessment needs</b> at both the individual and system levels as the foundation of an ideal WBA system<b>. This study contributes to current evidence by demonstrating how Appreciative Inquiry can reconceptualize systems of WBAs beyond their traditional role in assessment <i>of</i> learning by also promoting assessment <i>for</i> learning.</b> <b>By integrating these perspectives, WBAs may evolve into systems that balance these two assessment functions and create a more supportive learning environment. However, several tensions emerged within this ideal system. Enabling shared responsibility may help bridge these competing needs and create the trust in WBAs that is essential among users. While these findings provide valuable insights, their generalizability may be limited by the exploratory design and context-specific participants group. Future work should focus on implementing and evaluating the ideal WBA system identified in this study, as well as exploring the broader applicability of Appreciative Inquiry approaches to WBA across diverse educational settings.</b>
Referenties:
<sup>1</sup>Anderson HL, Kurtz J, West DC. Implementation and Use of Workplace-Based Assessment in Clinical Learning Environments: A Scoping Review. Acad Med. 2021;96(11S):S164-S74.
<sup>2</sup>Massie J, Ali JM. Workplace-based assessment: a review of user perceptions and strategies to address the identified shortcomings. Advances in Health Sciences Education. 2016;21(2):455-73.
