Workplace-Based Assessments

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Workplace-Based Assessments (WBAs) are an essential part of training at ACEM. These are conducted in the ‘real-life’ clinical environment and provide a framework to support teaching and learning.

WBAs at ACEM will vary depending on your level of training (Provisional or Advanced; Early Phase or Late Phase) and type of placement (ED or Non-ED). 

This page is structured to help you navigate sections depending on your circumstances. Simply click on one of headings below to be taken straight to your area of interest or concern:

EM-WBA Instruments 
EM-WBA Requirements 
Due date for EM-WBAs - the progression milestone date
How to complete WBAs
Panel Review
Roles
Training 
Orientation Videos
Further Information
Contact & Help

What constitutes WBAs?

ACEM Workplace-Based Assessments consist of three main components: 

1. Emergency Medicine Workplace-Based Assessments (EM-WBAs)
  • EM-WBAs involve short periods of observation and/or discussion with a trainee in clinical practice, followed by structured feedback to the trainee and a rating of the trainee’s performance during the specified period.
  • It is required for all Advanced Trainees during ED Placements.
  • To learn more about EM-WBAs click here for a link to further down this page. 

2. In Training Assessments (ITAs)

  • A DEMT/Supervisor rates and provides structured feedback on a trainee’s overall performance during a placement.
  • It is required for all Provisional and Advanced Trainees for each placement.
  • To learn more about ITAs click here.
3. Structured References (SRs)
  • The assessment is completed in confidence by a FACEM who has directly supervised the trainee, and identifies strengths and weaknesses in a number of areas of practice and serves as an indicator of the trainee’s suitability to progress into Advanced Training.
  • It is required for all Provisional Trainees.
  • To learn more about Structured References click here.
 

Emergency Medicine Workplace-Based Assessments (EM-WBAs)

EM-WBAs involve short periods of observation and/or discussion with a trainee in clinical practice, followed by structured feedback to the trainee and a rating of the trainee’s performance during the specified period.

EM-WBAs have an emphasis on providing good quality feedback, enabling trainees to assess their own learning along with using the feedback to inform and develop their own practice. EM-WBAs are a requirement for Advanced Trainees during ED placements only. Click on the links below to access the sections on this page:
 

EM-WBA Instruments 

The set of EM-WBA instruments in Advanced Training are outlined in the table. Information on the other two WBA instruments at ACEM, Structured References and In-Training Assessments, can found at their respective webpages.

 
Instrument Description Form 
(paper-based)
Guidelines
Direct Observation of Procedural Skills (DOPS) The trainee is directly observed whilst performing a specific clinical procedure, to assess and provide feedback on trainee performance of the procedure. DOPS hard copy form DOPS guidelines
Mini-Clinical Evaluation Exercise (Mini-CEX) The trainee is directly observed whilst performing a focused clinical task during a specific patient encounter, to assess and provide feedback on trainee performance in the patient encounter. Mini-CEX hard copy form Mini-CEX guidelines
Case-based Discussion (CbD) The assessor engages the trainee in discussion of a selected case, which the trainee managed, to assess and provide feedback on trainee’s clinical reasoning and decision making. CbD hard copy form CbD
guidelines
Shift Report The trainee is observed for the duration of a clinical shift, to assess and provide feedback on trainee performance during a discrete time period of clinical work. Shift Report hard copy form  Shift Report guidelines


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EM-WBA Requirements

All ACEM trainees are required to complete the specific WBAs according to their stage of training. Advanced Trainees are required to continuously complete EM-WBAs in any ED placement they undertake. This is required irrespective of other components of the FACEM Training Program the trainee is yet to complete (Fellowship Exam, Research requirement, Paediatric requirement etc).

Compliance refers to any WBA requirements, rate of completion requirements, and any other requirements as specified by the Council of Education (or delegated entity). The three main elements for EM-WBA compliance are:
  • Rate of completion for phase
  • Minimum complexity for phase
  • Minimum instrument numbers for phase.
All Advanced Trainees are expected to complete at least one (1) EM-WBA per month, while they work in ED placements. This expectation continues until the trainee is elected to Fellowship, regardless of the other ACEM requirements the trainee is undertaking. The table below represents the minimum EM-WBA requirements for Advanced Training: you can download this ACEM EM-WBA requirements table as a PDF.

WBA Requirements based on Early and Late Phase Training
*Trainees progressed to the maintenance pathway in Late Phase Advanced Training are required to complete the ‘Late Phase’ EM-WBAs until elected to Fellowship


Part-time training

The minimum rate of completion, as indicated below, is required whether the trainee is working full-time or part-time within an ED placement. For example, over a six month term from the 01/08/2016 to 29/01/2017, a trainee that is working part time in an ED must complete the same minimum number of EM-WBAs as another trainee who is working full time in an ED. 

Trainees working two x part-time placements in an ED are required to split their EM-WBA requirements evenly across both sites. A minimum of two individual instruments must be completed at each site. For example, 1 x DOPS and 1 x CbD at Site A, and 1 x Mini-CEX and 1 x Shift Report at Site B.

Rate of completion requirement

All Advanced Trainees are required to comply with the rate of completion requirements for their phase of training. This also applies to any periods of remediation or conditional progression. 

Trainees who do not meet the rate of completion requirement for each instrument may be remediated for non-compliance when they are reviewed by a WBA Panel. Trainees may complete more than the minimum EM-WBAs within a three or six month timeframe, but the rate of completion requirement will continue to apply in the next three or six month timeframe.
 
  • For example, an Early Phase Advanced Trainee completing 3 Mini-CEXs in their first 3 months of ED time must also ensure they complete one more Mini-CEX in the next 3 month period they work in ED. The total amount of completed Mini-CEXs in the 6 month period is 4. 

DOPS Procedure Requirement 

No more than one DOPS can be completed on a single procedure to fulfil the minimum requirements. Trainees are welcomed and encouraged to complete repeated DOPS on the same procedure to facilitate and demonstrate learning in a particular procedure, however subsequent completions of the same procedure cannot be counted towards the minimum number of DOPS required.

Core DOPS Procedure Requirement 

The Core DOPS are selected from the full procedures - view here

A trainee must complete at least five (5) DOPS assessments on single procedures selected from the Core DOPS Procedure List. Procedures in the list marked with an asterisk include an option, so to complete these procedures the trainee need only undertake one of the options presented (i.e. trainees do not need to complete both options to fulfil the core DOPS procedure requirement).

Completion of more than one option within the same procedure on the Core DOPS List can only be counted as one procedure towards the Core DOPS Procedure requirement.

It is expected that trainees will undertake the Core DOPS requirement as they progress through their training (i.e. trainees should not front-load or back-load all Core DOPS requirements in Early Phase or Late Phase Advanced Training). 


Core DOPS Procedure List
1. Advanced Airway (including both: 1. direct laryngoscopy, insertion of oral ETT, use of RSI technique [including drugs, stylet, bougie] and 2. setting up a transport ventilator)
2. Use of non-invasive ventilation device (either: adult or paediatric)*
3. Tube thoracostomy
4. DC Cardioversion
5. Emergent fracture/ dislocation reduction
6. Lumbar Puncture
7. Administration of procedural sedation
8. Central venous access (either: ultrasound guided central vascular access or insertion of a central venous line)*
9. Arterial line insertion
10. Performance of Focused Assessment Sonography in Trauma (FAST) (either: FAST or e-FAST)*

Complexity Requirement


The assessor selects the complexity of the patient or case, depending on the context.
Download the Case Complexity tool.

Patient Case Complexity Descriptors
 
Level of cases Description Modifiers Examples of cases
Low complexity A patient with a single-system presentation, with minimal complications (medical and/or social) and responsive to first line treatment.

A patient with a self-evident diagnosis where management is straightforward.

A stable patient, with a common presentation or a clear diagnosis.
No modifiers such as language, mental health status, social, representation or inconsistent clinical findings impacting on assessment or management –see Curriculum Framework. Isolated limb fracture

Renal colic

DVT

Cellulitis

Pneumonia
Medium complexity A patient with multi-system presentations, and minimal complications.

A patient with a single-system presentation and multiple or significant complications.

A patient with a single-system presentation and multiple or significant co-morbidities.

A patient with a single-system presentation with at least one modifier.

A stable patient, without a clear diagnosis.
At least one modifier such as language, mental health status, social, representation or inconsistent clinical findings impacting on assessment or management –see Curriculum Framework. Fracture with nerve/neurovascular compromise.

Syncope/ abdominal pain/ chest pain with at least one modifier.

STEMI etc.
High complexity A patient with multi-system presentations, multiple or significant complications.

A patient with multi-system presentations with multiple or significant co-morbidities.

A patient with multi-trauma.

An unstable/deteriorating patient, without a clear diagnosis.

A patient presenting with a life or limb threatening condition.
At least two modifiers such as language, mental health status, social, representation or inconsistent clinical findings impacting on assessment or management –see Curriculum Framework. Elderly patient with fracture of secondary to syncope on oral anticoagulants.

Undifferentiated shock.

Immunocompromised patient with shortness of breath with renal failure.

GI bleed patient with chest pain on warfarin with mechanical valve.
 

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Due date for EM-WBAs - the progression milestone date


All EM-WBAs are due by the time the trainee has accrued the minimum training time for the phase. This date is called the 'progression milestone'. The progression milestone date is the minimum training time requirement for the relevant phase (Early, Late, Discretionary, Maintenance Pathway).

The progression milestone date is unique to each trainee. The progression milestone can be calculated using the 'Monitoring My Progress' page on the trainee’s Member Portal. The date is unique to each trainee because time accrual is not necessarily aligned to term dates. Training time is accrued individually for each trainee due to the flexibility of the FACEM Training Program. 

The progression milestone date for each trainee, for each phase, will differ for each trainee according to their FTE status, site accreditation limits, leave from training, when they have completed Non-ED placements, etc. Trainees who have not completed the correct minimum amount of instruments, complexity or rate of completion may be placed into remediation at this point for non-compliance. 

Progression milestone date - Early Phase example

When the trainee has accrued 12 months of ED time, the trainee will be assessed against Advanced Training Stage 1. This standard applies regardless of which other time requirements the trainee has completed, or if they are compliant:
  • The trainee progressed to Early Phase Advanced Training on 17/09/2016.
  • The trainee works in ED placements for 12 months from this date.
  • The minimum number of EM-WBAs for this trainee is due by the time the trainee has accrued 12 months of ED time in Advanced Training.
  • The due date for this trainee's Early Phase EM-WBAs is 17/09/2017
Progression Milestone date - Late Phase example

When the trainee has accrued 18 months of ED time, the trainee will be assessed against Advanced Training Stage 3. This standard applies regardless of whether the trainee has completed all their other training time requirements, or if they are compliant.
  • The trainee progressed from Early Phase Advanced Training to Late Phase Advanced Training on 12/06/2016, but works in Critical Care.
  • The trainee works in Critical Care for 12 months (12/06/2016 - 12/06/2017).
  • The trainee is reviewed for Critical Care requirement after 6 months (11/12/2016).
  • The trainee is reviewed for Non-ED requirement (using rest of Critical Care time) after the second block of 6 months (06/06/2017).
  • The trainee comes back to work in ED for 12 months (07/06/2017 - 06/06/2018).
  • The trainee works in another ED for 12 months (07/06/2018 - 08/06/2019).
  • The trainee is reviewed for 18 months ED Late Phase after 6 months in this ED (13/12/2018).
  • The trainee is assessed against new Fellow standard.
Maintenance Pathway in Late Phase

When trainees have been progressed to Maintenance Pathway in Late Phase Advanced Training, they are required to continue completing EM-WBAs if they continue working in ED placements. Trainees who have met the minimum time requirement for ED time in Advanced Training, and continue working in ED placements, will be required to continue completing EM-WBAs. Those trainees in Maintenance Pathway in Late Phase are required to complete EM-WBAs as per 'Late Phase', including the minimum rate of completion and complexity requirements. This is required until the trainee is elected to Fellowship. For every 6 months FTE the trainee remains in the Maintenance Pathway in Late Phase, they will be reviewed for progression by the WBA Panel. 

Trainees can be remediated for non-compliance or for not maintaining the required standard in the Maintenance Pathway in Late Phase.

Transition period

All trainees who had 6 months or less of ED time remaining at the start of the 2015 training year are required to complete the "transition set" of EM-WBAs:
  • 2 Mini-CEX (at least 1 at high complexity)
  • 2 CbDs (at least 1 at high complexity)
  • 2 Shift Reports
Trainees have up to 6 months FTE in ED placements from the 2015 training year to complete the above EM-WBAs.

Once the transition set is completed, or when 6 months FTE of training time in ED placements from the 2015 training year is completed (whichever comes first), the trainee will be reviewed by the WBA Panel and a progression outcome provided. 

Trainees who have completed the transition set, are awaiting WBA Panel review, and are continuing in ED placements are required to continue completing EM-WBAs as per 'Late Phase' minimum rate of completion and complexity requirements. 

Trainees who have completed the transition set, are progressed to the Maintenance Pathway in late Phase, and continue in ED placements, are required to continue completing EM-WBAs as per 'Late Phase' minimum rate of completion and complexity requirements. 

Read more about the transition set requirements here 

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How to complete WBAs

ITA completion

ITAs are to be submitted by the DEMT / Supervisor of the trainee in their training placement at set dates throughout the training year. There is a three week window to submit the ITA, two weeks before the 'due date' and one week after the 'due date'. The due dates for 2017 can be found at Manage Your Training.

EM-WBA completion

EM-WBA forms must be entered online within seven days of the assessment occurring. 
Either the Trainee or Assessor can enter the form in their Member Portal, but the assessment must be verified by the WBA Assessor to be completed in full. 

Assessors have five days from when the form was entered online to verify and 'submit' the form online. Trainees have two days from when the Assessor has submitted the form to provide their evaluation. 

WBA expiry

Trainees may have one (1) opportunity per EM-WBA form to extend the submission date.
This opportunity can only be granted if the Trainee or Assessor contacts the College in writing within 72 hours of the form expiry date wba@acem.org.au Extensions beyond this timeframe are not permitted.

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WBA Panel Review

Overview

ACEM Regional Workplace-Based Assessment (WBA) Panels meet approximately one month after each time-check date, approximately eight times a year. The Central WBA Panel meets approximately eight times a year to conduct audits and to complete reconsiderations.

All ACEM trainees are reviewed for progression by their Regional WBA Panel. After the WBA Panel review, each trainee will receive a WBA Panel Report containing the outcomes of the review. The WBA Panel report will also include feedback about compliance with the assessment requirements and feedback on performance within the trainee’s stage of training. All DEMTs and Local WBA Coordinators are sent a summary of the WBA Panel review outcomes and reports for any trainees reviewed at their site.
  
WBA Panel Review points

Trainees are reviewed by the Regional WBA Panels when they reach a progression point.
Any trainee who has reached a progression milestone within the training program will be reviewed at the next Regional WBA Panel meeting after their time is approved. Trainees who have not reached a progression milestone will not be reviewed.

Trainees can be remediated at a progression review for non-compliance or for not meeting the required standard for their stage of training as outlined in the ACEM Curriculum Framework.

All ACEM trainees are reviewed for a progression outcome at the completion of the minimum training time required in each of the following stages of training:
  • Provisional Training time (+/- Structured References)
  • Early Phase ED time in Advanced Training
  • Late Phase ED time in Advanced Training
  • Critical Care time in Advanced Training
  • Non-ED time in Advanced Training
  • Discretionary time in Advanced Training
  • Advanced Training Completed
  • end of any remediation period (as relevant)
  • end of any conditional progression period (as relevant)
  • end of each 6 months FTE period in Maintenance Pathway, for each stage of training (as relevant).
What information does the Regional WBA Panel review?

All Regional WBA Panels view de-identified data, which includes:
  • In-Training Assessments (ITAs) completed on the trainee for the stage of training
  • EM-WBAs completed by the trainee (ED reviews only)
  • Learning Needs Analysis (LNAs) completed by the trainee and DEMT/Supervisor
  • Structured References (Provisional reviews only).
  • WBA Panel Report with remediation or progress with conditions outcome (as relevant).

What are the outcomes of Regional WBA Panel review?

All training and assessment information for each trainee, relevant to their stage of training, is reviewed by the Regional WBA Panel. The individualised feedback within the WBA Panel report is based on all of this information, and is intended to allow the trainee to track their progress on the ACEM Specialist Training pathway. All feedback will refer to the learning outcomes within the stages of training for each domain within the ACEM Curriculum Framework.
 
The outcomes of a progression review by the WBA Panel include the following:
  • progress to next stage of training (or to Maintenance Pathway)
  • progress to next stage of training, with conditions
  • remediation period, with remediation requirements to complete.
Remediation outcome

Trainees subject to remediation requirements may have increased minimum training time requirements, in any discipline, as specified by the WBA Panel. 

All trainees placed into a remediation period will be required to complete a Learning Needs Analysis (LNA). This applies to all training types for which the trainee is placed into remediation, including ED, Non-ED, Critical Care, or Discretionary. Trainees placed into ED training remediation will be required to complete EM-WBAs as specified in their individualised remediation plan (as detailed below under 'WBA Panel review'). 
  • The minimum remediation time for non-compliance is three months FTE.
  • The minimum remediation time for not meeting the required standard is six months FTE.
  • The minimum remediation time for non-compliance and not meeting the required standard is six months FTE.
The WBA Panel may, however, alter the remediation timeframe according to the specific needs of the trainee. This may include a longer remediation time as a result of non-compliance if the trainee had many EM-WBAs to catch-up in their remediation period. 

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WBA roles

All ACEM Trainees

EM-WBAs are a requirement in ED placements during Advanced Training. Provisional Trainees may also complete EM-WBAs however they are not a requirement. The EM-WBAs can be submitted by the trainee through the ACEM Member Portal, and verification by the Assessor is required to complete the assessment in full. If the WBA Assessor does not verify and submit the assessment, it will expire and another assessment must be completed by the trainee.

All FACEM or FRACP Assessors

All FACEMs and FRACPs are eligible to undertake WBAs as an assessor. The EM-WBAs can be submitted through the ACEM Member Portal by the Assessor. No verification step is required if the Assessor submits the form online.

Local WBA Coordinators

Local WBA Coordinators provide oversight and coordination of the WBA system at the local level. One to two FACEMs have been appointed to each hospital with an ACEM-accredited ED. All Local WBA Coordinators have access to WBAs at their site via the Member Portal. The remediation/ conditional progression report any trainee receives is also provided to the Local WBA Coordinators at the trainee’s current site.

DEMTs

All DEMTs have access to WBAs at their site via the Member Portal. The remediation/ conditional progression report any trainee receives is also provided to the DEMTs at the trainee’s current site. 

Regional WBA Coordinators

Regional Coordinators oversee the implementation of WBAs in their region, and provide feedback about WBAs to the sites in their region. All Regional Coordinators have access to WBAs within their region via the Member Portal. The current Regional WBA Coordinators are:
  • NZ: Stuart Barrington-Onslow
  • ACT & NSW: James Kwan
  • QLD: Shane George, James Innes
  • VIC: Victor Lee
  • TAS : Kate Field
  • SA & NT: Sandra Brownlea
  • WA: Megan Foster.

WBA Regional Panel

All completed WBAs (ITAs, Structured References and EM-WBAs) build a portfolio of evidence for a trainee. At progression milestones, a Regional WBA Panel reviews this portfolio and provides an outcome. The Regional WBA Panels are responsible for:
  • setting the standard for WBA at ACEM
  • the data review of the WBAs completed during Provisional and Advanced Training
  • reviewing trainee data and providing feedback
  • determining progression and/or remediation processes for trainees.
WBA Central Panel 

The Central WBA Panel oversees and governs the implementation of WBAs. The Central WBA Panel monitors inter-regional and intra-regional consistency in WBAs and conducts reconsiderations related to Regional WBA Panel outcomes.

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WBA Training 

The College has developed various training options that cover the principles of fair and objective assessment, how to perform WBAs and how to provide constructive feedback. 

Member Portal

The trainee, their site DEMTs and their site Local WBA Coordinators can review their EM-WBA and ITA performance at any time within the member portal. A report of all WBAs can be downloaded into an Excel document by the trainee, Assessor, Local WBA Coordinator or DEMT.

The report can be used to track the trainee's performance. DEMTs and Trainees can use the stages within the ACEM Curriculum Framework as a reference in order to compare the trainee’s WBA ratings with the standards required as they progress through the FACEM Training Program. 

Email the WBA team for guidelines on how to download the report. 

Online Assessor Training

All Fellows and trainees are encouraged to complete the online training modules. The online modules available to complete, include: 
Training Workshops 

More than 260 FACEMs have attended face-to-face Local WBA Coordinator training workshops in the past three years.  

The online training modules cover most of the content, and additional resources can be obtained by emailing the WBA team at the College. 

 
CPD Activity

Completing ACEM WBA Assessor Training (face-to-face and online modules) and completing WBA assessments contribute towards ACEM CPD requirements. To add WBA activities to your CPD Online record, use the Quick Find facility within Activity Editor to search for WBA or use the drop down menus:
 

CPD Category Activity Type Example WBA Activity
Self-Directed Learning Online educational activity ACEM - Workplace-Based Assessment (WBA) modules and resources
Group Learning Workshops and Training - EM related WBA Assessor and Supervisor Training Workshop
Teaching, Research & Educational Development Workplace-Based Assessment-Assessor Workplace-Based Assessments (WBAs) - includes preparation, observation and feedback
Quality Enhancement Workplace-Based Assessment-Trainee being assessed Workplace-Based Assessment (WBAs) - Trainee being assessed
 

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WBA Orientation Videos

These videos include observation/discussion with the trainee to the provision of feedback. 

Orientations to WBAs at ACEM  



Case-based Discussion (CbD) 



Mini-Clinical Evaluation Exercise (Mini-CEX) 



Direct Observation of Procedural Skills (DOPS) 



Shift Report


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Assessor Calibration Resources

All Local WBA Coordinators are encouraged to run an assessor calibration session with their FACEM and FRACP colleagues. The resources for use are:
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Further Information

Further information on the ACEM Curriculum Framework is available on the Curriculum Framework page.
 

Contact & Help

If you would like more information about the ACEM WBA system or WBA Assessor Training contact wba@acem.org.au

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