MRCGP Workplace Based Assessment (WPBA) in GP Training

Workplace based assessment (WPBA) is one of the 3 components of the MRCGP exam.  In this article, Dr Mahibur Rahman provides an overview of WPBA – what it covers, how to gather evidence for it, and when you need to complete certain milestones.

What is WPBA?

WPBA is a continuous assessment process throughout the 3 years of GP training. It is designed to support development through feedback on various competences both in hospital and GP posts.

It is based around 13 areas of professional competence:

1. Communication and consultation skills – use of recognised consultation techniques to communicate effectively with patients
2. Practising holistically – using physical, social and psychological context to provide holistic care
3. Data gathering and interpretation – effective history taking, choice of examinations, investigations and their interpretation
4. Making a diagnosis and making decisions – a conscious, structured approach to decision making
5. Clinical management – recognition and management of common medical conditions in primary care
6. Managing medical complexity and promoting health – aspects of care beyond managing straightforward problems, including management of co-morbidity, uncertainty, risk and focusing on health and well-being rather than just illness
7. Organisation, management and leadership – understanding the use of computer systems in practice, change management, and the development of organisational and clinical leadership skills
8. Working with colleagues and in teams – effective team working and the importance of the multi-disciplinary team
9. Community orientation – management of the health and social care of the practice population and local community
10. Maintaining performance, learning and teaching – maintaining performance and effective CPD
11. Maintaining an ethical approach to practice – practising ethically, with professional integrity and a respect for diversity
12. Fitness to practise – the doctor’s awareness of when his/her own performance, conduct or health, or that of others, might put patients at risk, and taking action to protect patients
13. Clinical examination and procedural skills – competent physical examination of the patient with accurate interpretation of physical signs and the safe practice of procedural skills

These competences are assessed in different ways throughout training, the idea being that you should achieve the standard expected of a qualified GP in all of them before you complete training.

How do I meet the requirements for WPBA?

You will need to gather evidence that you have achieved the competences using various tools. Some are used only in the GP setting, some only in hospital while others can be used in both settings. The tools are:

Tool	Hospital	GP
Case-based Discussion (CbD) A structured interview assessing professional judgement in clinical cases – based around real cases you have seen.	☑	☑
Consultation Observation Tool (COT) A review of patient consultations by your trainer – either video recordings or direct observation in a joint clinic.		☑
Multi-Source Feedback (MSF) Collection and reflection on feedback from colleagues on your clinical and professional skills. This is from clinicians only in hospital, and both clinicians and non-clinicians when in GP.	☑	☑
Patient Satisfaction Questionnaire (PSQ) Feedback from at least 40 patients on your empathy and relationship building skills during consultations.		☑
Clinical Examination and Procedural Skills (CEPS) Assessment of various clinical examination skills and competence in performing key procedures – this includes intimate examinations.	☑	☑
Clinical Evaluation Exercise (MiniCEX) Assessment of clinical skills, attitudes and behaviours in a secondary care setting – based on direct observation of your interaction with a patient for around 15 minutes.	☑
Clinical Supervisors Report (CSR) A short, structured report from your clinical supervisor looking at the competences in 4 clusters: relationship, diagnostics, management and professionalism. This is usually completed for each hospital post, although it can be used in GP posts.	☑	(☑)
Learning Log This is your personal learning record and should be used to reflect regularly on learning experiences. These can be linked to relevant curriculum headings.	☑	☑
Personal Development Plan (PDP)  This is used to allow you to demonstrate that you can assess your learning needs and plan actions to meet them. Items in the plan should be reviewed with evidence to demonstrate that you have achieved them.	☑	☑

Are there a minimum number of assessments I need to complete?

You will usually meet your educational supervisor every 6 months for a review of your progress. You will be asked to complete a self-assessment prior to each meeting. The guidance of how often each tool should be used is shown below – remember that the quality of entries and assessments is as important as the quantity. Some doctors will need to do more than the minimum to reach a suitable standard. The minimum evidence given here is based on a 3 year rotation with 18 months in hospital and 18 months in practice for a full time trainee.

Year of training	Minimum evidence
GP ST1 Prior to 12 month review	6 x mini-CEX (if in secondary care) / 6 x COT (if in primary care) 6 x CbD 2 x MSF (each with a minimum of 5 replies from clinicians plus 5 non-clinicians if in primary care) 1 x PSQ (if in primary care) CEPS as appropriate 1 x CSR from each hospital post
GP ST2 Prior to 24 month review	6 x mini-CEX (if in secondary care) / 6 x COT (if in primary care) 6 x CbD 1 x PSQ (if in primary care and not already completed in ST1) CEPS as appropriate 1 x CSR from each hospital post
GP ST3 Minimum prior to 36 month review	12 x CbD 12 x COT 2 x MSF (each with 5 clinicians and 5 non-clinicians) 1 x PSQ

Less than full time trainees, and those on 4 year rotations (including academic trainees) have different requirements – you can read more about this here: http://www.rcgp.org.uk/training-exams/mrcgp-workplace-based-assessment-wpba/less-than-full-time-trainees.aspx

Summary

WPBA is an important component of the MRCGP, and alongside the MRCGP AKT and CSA, assessed readiness for independent practice as a GP. It also offers a way to record your learning, gain feedback on areas to improve and to provide evidence of your achievements. It is important to keep on top of the different learning tools and gather the necessary evidence in a timely manner so you can successfully progress through training.

Further reading:

RCGP WPBA overview: http://www.rcgp.org.uk/training-exams/mrcgp-workplace-based-assessment-wpba.aspx