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Med Teach. 2016 Dec;38(12):1188-1198. Epub 2016 Sep 14.

A BEME (Best Evidence in Medical Education) review of the use of workplace-based assessment in identifying and remediating underperformance among postgraduate medical trainees: BEME Guide No. 43.

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a Education, Innovation and Research , Royal College of Physicians of Ireland , Dublin , Ireland.
b School of Medicine, College of Medicine and Health Sciences, Brookfield Health Sciences Complex, University College Cork , Cork , Ireland.
c Discipline of Physiotherapy, Department of Clinical Therapies, Faculty of Education and Health Sciences , University of Limerick , Limerick , Ireland.
d Centre for Medical Education, Faculty of Medicine, McGill University , Montreal , Quebec , Canada.
e Faculty of Health, Medicine and Life Sciences , University of Maastricht , Maastricht , The Netherlands.
f Research Unit, Royal College of Physicians and Surgeons of Canada , Ottawa , Canada.
g Faculty of Medicine , University of Ottawa , Ottawa , Ontario , Canada.



The extent to which workplace-based assessment (WBA) can be used as a facilitator of change among trainee doctors has not been established; this is particularly important in the case of underperforming trainees. The aim of this review is to examine the use of WBA in identifying and remediating performance among this cohort.


Following publication of a review protocol a comprehensive search of eight databases took place to identify relevant articles published prior to November 2015. All screening, data extraction and analysis procedures were performed in duplicate or with quality checks and necessary consensus methods throughout. Given the study-level heterogeneity, a descriptive synthesis approach informed the study analysis.


Twenty studies met the inclusion criteria. The use of WBA within the context of remediation is not supported within the existing literature. The identification of underperformance is not supported by the use of stand-alone, single-assessor WBA events although specific areas of underperformance may be identified. Multisource feedback (MSF) tools may facilitate identification of underperformance.


The extent to which WBA can be used to detect and manage underperformance in postgraduate trainees is unclear although evidence to date suggests that multirater assessments (i.e. MSF) may be of more use than single-rater judgments (e.g. mini-clinical evaluation exercise).

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