Rethinking Workplace-Based Assessment: The Costly Illusion of Authenticity
Bibliographic record
Abstract
ABSTRACT: The current practice of workplace-based assessment (WBA) in many health professions education contexts does not live up to the expectations regarding both WBA's formative (for learning) and summative (for decision-making) potential. In this Scholarly Perspective, the authors argue that the ambition to observe and assess so-called authentic behavior of trainees plays a role in this. According to the literature, for assessments in the workplace to be valid, direct observation of authentic behavior of trainees performing authentic clinical work is key. Guidelines, therefore, advise supervisors to observe their trainees silently from a distance, while avoiding direct eye contact with the patient. If these guidelines are followed, trainee-patient-supervisor situations that could be used for teaching in dialogue, with bidirectional observations, must be transformed into distanced, silent, unidirectional assessments. Research outcomes, however, suggest that direct observation and assessment of true authentic behavior of trainees in true authentic clinical work is an illusion; the presence of an observing supervisor, however distanced, changes the situation and, with that, the conduct of the trainee. Additionally, this illusion is costly because distancing the supervisor from the trainee comes at the expense of teaching and learning in dialogue. Although assessments in the workplace may serve summative purposes, they do not fit well with formative goals of health professions education. Therefore, WBA's current central position in health professions education, which is based on both its summative and formative promises, should be questioned. More specifically, the prominent role of assessment when supervisors are present while their trainee works with a patient should be reconsidered. The authors propose to use these trainee-patient-supervisor situations predominantly for teaching and learning, with bidirectional direct observation and dialogue, and then determine the needs for and purposes of assessment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.090 | 0.160 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.003 | 0.028 |
| Scholarly communication | 0.014 | 0.013 |
| Open science | 0.004 | 0.016 |
| Research integrity | 0.004 | 0.012 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".