The role of feedback in improving the effectiveness of workplace based assessments: A systematic review (BMC Medical Education)

Background: Although there is considerable emphasis placed on workplace based assessment as a method of formative performance assessment, there is limited evidence in the current literature regarding the effectiveness of workplace based assessment in changing the behaviour of doctors and improving their performance. The aim of this systematic review is to elucidate the efficacy of feedback in improving the effectiveness of workplace based assessments in postgraduate medical training. Methods: Searches were conducted using the following bibliographic databases to identify original published studies related to WBA and the role of feedback: Medline (1950-December 2010), Embase (1980-December 2010) and Journals@Ovid (English language only, 1996-December 2010). Studies which attempted to evaluate the role of feedback in WBA (multi-source feedback, direct observation of procedural skills, mini-clinical evaluation exercise, procedure based assessment or case-based discussion) involving postgraduate doctors were included. Results: 15 identified studies met the inclusion criteria and minimum quality threshold. They were heterogeneous in methodological design. 7 studies focussed on multi source feedback, 3 studies were based on mini-clinical evaluation exercise, 2 looked at procedural based assessment, one study looked at workplace based assessments in general and 2 studies looked at a combination of 3 to 6 workplace based assessments. 7 studies originated from the United Kingdom. Others were from Canada, the United States and New Zealand. Study populations were doctors in various grades of training from a wide range of specialties including general practice, general medicine, general surgery, dermatology, paediatrics and anaesthetics. All studies were prospective in design, and non-comparative descriptive or observational studies using a variety of methods including questionnaires, one to one interviews and focus groups. Conclusions: The evidence base contains few high quality conclusive studies and more studies are required to provide further evidence for the effect of feedback from workplace based assessment on subsequent performance. There is, however, good evidence that if well implemented, feedback from workplace based assessments, particularly multisource feedback, can be an effective and feasible way to support professional development.