Hunter New England Workplace Based Assessment Program

Workplace Based Assessment is a form of programmatic assessment, which assesses the performance of doctors in their actual clinical environment. It is the direct observation of IMGs in their workplace.

It involves having different assessment tools used by multiple assessors in various clinical settings over an extended period.

The process assesses the candidate’s clinical skills and performance as well as their communication and teamwork skills.

The HNE WBA program uses 3 assessment tools:

• Mini-CEX (Mini Clinical Evaluations)
• CBD (Case Based Discussions)
• 360° Assessment (multi-source feedback).

At the conclusion of each Mini-CEX and CBD assessment, candidates are provided with constructive feedback by the assessor.

The WBA program is a 6 month (26-week) program offered to employees of Hunter New England LHD at the following locations:

• John Hunter Hospital, Royal Newcastle Centre, or Rankin Park Hospital
• Belmont Hospital
• Maitland Hospital
• Calvary Mater Newcastle
• Newcastle Mental Health Services
• Armidale Rural Referral Hospital
• Tamworth Rural Referral Hospital
• Manning Base Hospital, Taree

It uses 3 assessment tools:

• Mini Clinical Evaluations (Mini-CEX) - 12 in total
• Case Based Discussions (CBD) - 6 in total
• 360° Assessment (multi-source feedback) - 12 in total (6 in month 1 and 6 in month 5).

WBA Program number of cohorts per year:

• We run 2 cohorts per year. Cohort 1 is in February and Cohort 2 is in August.

The Mini-CEX involves the direct observation of a candidate in a clinical encounter with a real patient for 15-20 minutes, followed by immediate feedback by the assessor on their performance for a further 10 – 15 minutes.

The candidate’s performance in the Mini-CEX is rated by the assessor using an electronic standardised structured rating form. This form is available on the iPad provided to the candidate at commencement of program.

Each candidate is required to undertake 12 Mini-CEX assessments – 2 in each of the 6 clinical areas:

• Medicine
• Surgery
• Emergency medicine
• Mental health
• Paediatrics
• Women’s health.

The goal of a Case Based Discussion (CBD) is to assess the candidate’s ability to discuss with the assessor the clinical reasoning involved in:

• the clinical assessment
• investigation
• treatment
• follow-up
• overall clinical care of a particular patient.

The CBDs also assess the candidate’s record keeping abilities.

The assessment takes approximately 20 minutes, followed by immediate feedback by the assessor on performance for a further 10–15 minutes.

The candidate’s performance in the CBD is rated by the assessor using an electronic standardised, structured rating form.

This form is available on the iPad provided to the candidate at commencement of program.

• Candidates must undertake 6 CBDs selected from their own patient cohort. The CBDs must be completed over the course of the 26-week WBA period.
• Four CBDs will be conducted from the candidate’s patient cohort in the candidate’s allocated discipline.
• Two CBDs will be conducted using patients that the candidate had been directly involved in managing and who had active co-morbid conditions in other disciplines, for example a surgical patient with a co-morbidity in mental health.

For successful completion, WBA candidates must be competent in:

• Nine of the 12 Mini-CEX
• Five of the 6 CBDs
• the 6-month 360° Assessment (summative).

Each candidate must read the Candidate Handbook which is supplied at the start of the program and ensure they follow the rules of each clinical assessment.

A 360° Assessment is multi-source feedback assessment, which provides insight and evidence of a candidate’s performance over time from medical colleagues and co-workers.

It does not relate to any one specific patient encounter; however, it is a broader review of a candidate’s overall skills and ability.

These assessments are aimed at improving workplace performance, with 360° assessments being completed during month 1 and month 6 of the program.

For more information, please contact the HNEHD WBA Office on HNELHD-WBA@health.nsw.gov.au or phone (02) 4985 3313.

The Governance Committee is the body responsible for the overall conduct of the AMC (Australian Medical Council) Workplace Based Assessment (WBA) Program on behalf of Hunter New England Local Health District (HNELHD) and the University of Newcastle.

The Governance Committee:

• oversees the major strategic and operational functions of the WBA Program in accordance with HNELHD's Australian Medical Council Accreditation guidelines
• represents the interests of the partners, such as HNELHD and the University of Newcastle
• monitors the ongoing performance of the WBA Program
• defines responsibilities and accountabilities within the WBA Program Committees
• approves any major amendments to the methodology of the program
• reviews WBA Program finances
• undertakes strategic planning for ongoing WBA.

The Governance Committee meets twice during each 6-month assessment period—once at the beginning and at the end—unless otherwise requested by the Governance Committee Chair.

The 360° Review Panel is convened to review the WBA Program candidate month 1 (formative) and month 6 (summative) 360° results.

The 360° Review Panel:

• reviews the month one and month six 360° assessment performance results from medical colleagues and co-workers
• identifies the competent (C) and not-competent (NC) candidates
• devises and oversees the feedback of results to all competent candidates at month one
• devises and oversees an appropriate and sensitive method of feedback to all candidates who are deemed not competent at month one and includes recommendations for remediation
• notifies the candidate with whom the Committee wishes to meet and advises that the candidate can invite an independent support person to be present but must not contribute to the discussion
• reports the outcome/ findings made at the 360 meetings to the WBA Governance Meeting.

The Appeals Committee is responsible for investigating and deciding on appeals lodged by WBA candidates. An appeal is submitted by the candidate by emailing HNELHD-WBA@health.nsw.gov.au

Appeals can be lodged by a candidate if they are appealing against a "Not Competent" result overall. Alternatively, candidates may still wish to lodge an appeal regardless of their overall result if they have a grievance.

Note: This document should be read with the WBA Grievance and Appeal Procedure document and flow-chart.

Appeals Committee functions:

• Investigate appeals lodged by candidates (at the end of the assessment period)
• Decide if the appeal should be dismissed and the result stands or if the appeal should be accepted and the candidate is offered a re-sit Mini-CEX, CBD, 360°
• Document the decision and rationale
• Notify the WBA Governance Committee of the outcome.
  • The WBA Governance committee then meet or consult to endorse the decision. The WBA director notifies the candidate of the outcome by letterhead.
  • If candidates are not satisfied with the decision of the WBA Appeals Committee, they have the option to lodge an external appeal with the AMC Appeals Committee.

To be eligible for the Standard Pathway (Workplace Based Assessment) as an international medical graduate, you must comply with the following requirements:

• Successfully complete and pass the AMC MCQ Examination.
• Provide evidence of English Language Proficiency, Primary Source Verification and obtain limited registration (for Area of Need) under the Health Practitioner National Law Act 2009.
• Be employed by Hunter New England LHD as a Medical Officer for 6 months prior to commencing the WBA Program at 0.6 FTE (equivalent 3 days per week) as a minimum.  This period could have been worked in previous years with a break in service and then returning to HNELHD.
• Have a contract of employment with HNELHD, for a period of 6 months prior to commencing the WBA Program.
• The period between the completion of the six-month pre-WBA employment period and the commencement of the next WBA Program.
• The entirety of the 26-week program, however we recommend that your contract also covers the 3 months following completion of the program to allow flexibility for AMC results panel to review and sign off.
• Provide evidence of completed supervisor reports, WRIG 30 or similar assessment forms, signed by your supervisor stating that you have satisfactorily completed 6 months of Hunter New England employment during the pre-WBA period.
• Provide evidence that you are registered to attend or have completed HNELHD International Medical Graduate Orientation Program.

To ensure an equitable application process, applicants will be waitlisted:

• in order of priority
• in accordance with their overall eligibility to join the program
• as their start date and the date they submit a formal application.

The program is 6 month or 26 weeks in duration. There are two Cohorts per year, Cohort 1 in February, and Cohort 2 in August.

There are 2 cohorts for the WBA Program each year.

The number of candidates accepted into a cohort will depend on availability of assessors over the 26-week period. Currently this is limited to 20 candidates per cohort.

The WBA Program costs $12,500, plus an additional AMC registration fee of approximately $1,000.

The first payment of $5,000 is to be paid at the mandatory WBA Candidate Information Session.

The remaining payment of $7,500 will be deducted approximately three months into the program.

Candidates must not apply for annual leave for a period exceeding two weeks during the 26-week assessment period.

Candidates are also required to declare if they have a personal, family or professional commitment that will result in them taking leave or prevent them from working for the entire 26-week assessment period.

Candidates on the WBA Program who successfully complete the program’s requirements are awarded the AMC Certificate, which provides a qualification required for registration.

To apply, you can fill out the AMC Workplace Based Assessment Program - Application Form.

The following professionals can be a WBA assessor:

• Any staff specialist
• VMO (Visiting Medical Officer)
• GP (General Practitioner) 
• Fellow
• Advanced trainee 
• CMO (Chief Medical Officer) who has maintained general registration for over 4 years.

An AMC requirement for Workplace Based Assessment is that all assessors attend an initial 2-hour assessor calibration session. This can be attended in person or virtually.

We provide an overview of the program and then there is peer review of calibration videos.

At the end of the calibration, we will sign you up for H.Prime (online platform used for assessments), get vendor information from you for honorariums.

You and the candidate will review an email from WBA office via H.Prime  outline the type of assessment (Mini-CEX or CBD), the candidate details and the time period for completion of the assessment.

• A Mini-CEX takes about 45 mins, as you have to find and consent the patient for the assessment prior to commencement of the assessment. The time spent with the candidate is approx. 30 mins.
• A CBD takes about 30-40 mins for reviewing of patient notes and discussion with the candidate.

We pay our assessors a small honorarium or assessment as a token of appreciation.

Recalibration is required every 2 years. This entails a 45-minute video that we ask you to watch which will include any updates that have occurred during this time.

If you or a colleague within Hunter New England LHD would be interested in being a WBA assessor, please reach out to our team on (02) 4985 3133 or email HNELHD-WBA@health.nsw.gov.au

Candidates seeking to have the result of an assessment reviewed should email the WBA Program Office no later than 3 working days after the result has been made available.

The candidate must clearly specify the error they believe has been made in the determination of their result and how they reached this conclusion, providing evidence and specific examples if possible.

The WBA Program Director may, in a timely manner, elect to seek a recommendation from the original assessor and may determine to:

1. leave the original result unchanged
2. amend the result; or
3. ask an independent assessor to reassess.

The WBA Program Director will email the candidate and assessor once a determination has been made.

Should a WBA Program candidate be deemed “Not Competent” overall, the candidate may lodge an appeal.  To lodge an appeal, the candidate must submit a written application with the WBA Program Office within 10 working days. Only appeals submitted to the WBA Program email account HNELHD-WBA@health.nsw.gov.au will be assessed, i.e. candidates are not to make appeals directly to individual assessors.

In response to an appeal application, the WBA Program Appeals Committee, which is independent of the Program Team and the WBA Governance Committee, is convened.

The Appeals Committee operates according to its Terms of Reference and will consider the following in relation to the AMC required assessments:

• candidate personal circumstances, for example illness during the assessment
• circumstances relating to the patient or the ward during the assessment, for example patient becoming unwell or a major disruption on the ward; and
• allegations that the assessor did not administer the assessment properly.

The WBA Program Appeals Committee may determine to:

• leave the original result unchanged
• amend the result
• approve the candidate to sit a supplementary assessment.

The Appeals Committee will not consider operational requirements or employment related matters, for example pre-WBA 26 weeks requirement, accommodations for unplanned absence from work during the WBA.

If the appeal process is exhausted at the level of Hunter New England LHD and the candidate has grounds for appeal, an appeal application can be lodged with the AMC through the WBA Guideline for Appeal process (refer to clause 5.2 Systematic Complaints).

Candidates wishing to appeal the outcome of AMC mandated assessments must apply via the Appeals Process to the Appeals Committee.

Should a WBA candidate’s circumstances require special consideration in relation to the operational requirements or employment related matters, for example pre-WBA working requirement, accommodations for unplanned absence from work during the WBA. The candidate must make a written submission to the WBA Program Director, who will consider the request according to Hunter New England LHD’s WBA special consideration guideline and provide a response with written reasons.

If the candidate disagrees with the decision of the WBA Program Director, they may seek a review of the decision by the Special Consideration Committee, comprising of the:

• Executive Medical Director
• Executive Director Workforce
• Operational Executive.

All requests for special consideration must be emailed to the WBA Program Director via the WBA Program office email at HNELHD-WBA@health.nsw.gov.au

• Case-based Discussion Assessment form – sample (PDF 486.34KB)
• 360° month one nominations (PDF 221.12KB)  
• Mini-CEX Assessment form – sample (PDF 424.37KB) 
• Term supervisor assessment form medical officer – WBA  (PDF 604.76KB)
• AMC Workplace Based Assessment Program – Application form  

• Candidate information booklet – June 2024 (PDF 825.75KB) 
• 2022 Special consideration WBA – Guideline (PDF 155.33KB)