Workplace-based assessment to support entrustment decision-making: Four sources of information

A program of assessment that enables summative decisions about the trainee's readiness, such as a clinical competency committee, requires a synthesis of various sources of information and sufficient data points. Besides information about knowledge and skills, assessed outside the workplace (written examinations and standardized skills tests), workplace-based assessment can be categorized into four sources of information about a trainee: direct observation, conversation, longitudinal observation, and evaluation of 'products' of patient care. Direct observation of a trainee happens during a natural patient care activity in an authentic clinical setting, usually 10 to 20 minutes, followed by a few minutes of focused feedback. Conversations are a five- to 20-minute one-on-one discussion with a trainee to probe knowledge, understanding, reasoning, and/or decision-making. Longitudinal observation or monitoring checks the natural, unplanned observation of a trainee over time by collaborators and others (including patients) who have natural encounters with the trainee, often in the form of multisource feedback. Product evaluation pertains to the assessment of trainees through their output of patient care that does not require their direct presence during the assessment. All four sources of information are discussed with examples and literature references. We end with notes on documentation of information, and feedback processes as an intrinsic component of workplace-based assessment.