ORIGINAL REPORTS What Evidence is There for the Use of Workplace-Based Assessment in Surgical Training? Joseph Shalhoub, BSc, MBBS, MRCS, FHEA, PhD,* ,† Alex Thomas Vesey, MBChB, MRCS, †,‡ and James Edward Frankland Fitzgerald, BA, BMBCh, MRCS, FHEA † * Imperial College London, UK; † Association of Surgeons in Training, London, UK; and ‡ University of Edinburgh, UK BACKGROUND: Recent years have seen broad changes in postgraduate training with a move toward structured formative and summative evaluation of trainees’ competen- cies using workplace-based assessment (WBA) tools. The fitness for purpose of these instruments in surgery has been much debated. The aim of this study is to explore the evidence underlying the introduction and ongoing use of WBAs in surgical training. METHODS: A critical literature review was conducted to identify studies evaluating the use of WBAs in postgraduate surgical training. The search was conducted using the electronic databases PubMed for full-text articles in English. Additional critical evaluations of the curriculum relating to WBAs were included. The articles were synthesized in a narrative review. RESULTS: The implementation of WBA requirements in surgical training has occurred despite a relative dearth of direct evidence of their efficacy and benefit. Studies and critical reviews are being regularly undertaken to ensure that supporting evidence is accrued and the drive for improve- ment and refinement is maintained. It is emerging that WBAs are (contrary to their current nomenclature) for- mative tools for feedback and hence learning. They can facilitate the progression toward expert practice at the center of the zone of proximal development and the higher levels of Miller’s pyramid, but fall short—owing to their focus on competence—of guiding surgical trainees to the higher levels of Maslow’s hierarchy. CONCLUSIONS: Limited evidence has potentially under- mined the introduction of WBAs in surgical training to date. There are misunderstandings regarding their use as either summative or formative educational tools. These shortcomings are an opportunity for further work in examining WBAs in their current or modified form. ( J Surg ]:]]]-]]]. J C 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.) KEY WORDS: education, training, surgery, assessment, workplace-based assessment, WBA COMPETENCIES: Practice-Based Learning and Improvement, Medical Knowledge, Interpersonal Skills and Communication INTRODUCTION Recent years have seen signi ficant reform in the delivery of postgraduate training and education across the medical pro- fession. In the United Kingdom, the “Modernising Medical Careers” (MMC) program introduced competency-based pro- gression within medical training. 1 Competency refers to the determination that a trainee has the requisite knowledge, skills, and attitudinal characteristics for independent practice as a specialist in their chosen discipline. The MMC replaced the time-based “Calman” system of traditional apprenticeship, 2 which in turn had replaced several different medical training systems that spanned the past century. Regarding surgical training, the Intercollegiate Surgical Curriculum Program (ISCP) 3,4 was developed because of the MMC to make explicit the competencies to be attained as necessary for progression, completion of training, and independent surgical practice. Workplace-based assessments (WBAs) are an integral component of the ISCP and sit amongst other forms of assessment, including formal postgraduate examinations and analysis of operative and procedural logbooks. There are a number of different types of WBA undertaken as part of the ISCP, which are summarized in Table. Key features common to WBAs include the collection of details of the learning event that forms the focus of the assessment, opportunity for both the trainee and trainer to enter free-text comments relating to the event or the feedback received, and mapping of the WBA to the ISCP surgical curriculum. For the 4 main Correspondence: Enquiries to Joseph Shalhoub, BSc, MBBS, MRCS, FHEA, PhD, Imperial College London, UK; e-mail: j.shalhoub@imperial.ac.uk Journal of Surgical Education  & 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved. 1931-7204/$30.00 http://dx.doi.org/10.1016/j.jsurg.2014.03.013 1