Do Supervised Learning Events reflect clinical competency and support ‘Trainee in Difficulty’ identification? Physician Trainees’ perceptions

Abstract
Objective
Training and assessment of postgraduate medical trainees has undergone a process of standardisation in recent years by using Workplace Based Assessments (WPBAs). WPBAs play a pivotal role in assessing competency and ensuring satisfactory training progress. From 2012 onwards, traditional WPBAs in the UK were replaced by Supervised Learning Events (SLEs) that include substantial formative feedback. SLE use are encouraged in identification and monitoring of training difficulties. Trainees’ perceptions of their value in identifying training difficulties and assessment of clinical competency are yet to be explored.

Methods
A mixed- methods study adopting Grounded Theory methods was conducted with Higher Specialty Trainees across three medical disciplines; individuals with several years of postgraduate experience. Participants completed an online questionnaire utilising both qualitative and quantitative questions (n=25). Subsequently, two focus groups were conducted to explore perceptions of the assessment process (n=14). Grounded Theory methods were used to develop codes for the qualitative data, with quantitative responses recorded using Likert rating scales.

Results
Multi-rater assessments were rated highest at assessing clinical competency, with directly-observed assessments rated lowest.
Five main themes emerged from the data:
1. Trainees attempted to present their ‘best-self’: tension was identified between formative and summative aspects of assessments
2. Assessment process mistrust: concerns regarding the permanency of recording suboptimal performance impaired assessment use
3. Cultural shift of feedback provision: an enhanced feedback culture was identified, with assessments acting as a ‘springboard’ for knowledge development
4. Assessor dependence: pivotal role the assessor plays in training difficulty identification
5. Task-specific nature: narrow remit led to assessments’ limited ability to capture trainee performance

Conclusions
Physician trainees associate SLE introduction with enhanced identification of training difficulties through an improved feedback culture. Threats to optimal SLE use include fear of repercussions of negative outcomes and trainees masking weaknesses.