Beyond a single ideal: An appreciative inquiry into students' perspectives on workplace-based assessment during clerkships.
TL;DR
This study explored undergraduate medical students' perceptions of WBAs during clerkships, using a strengths-based approach to envision an ideal WBA system and suggested that trustworthy WBA systems are best understood as sets of deliberate compromises negotiated in ongoing dialogue with students and assessors, rather than one-size-fits-all frameworks.
Abstract
INTRODUCTION Workplace-based assessments (WBAs) are central to evaluating clinical performance in clerkships, yet their design and implementation remain challenging. One major challenge is that WBAs inevitably rely on subjective human judgement. However, little is known about how undergraduate students perceive subjectivity in assessment and what they consider trustworthy assessment practices. We therefore explored undergraduate medical students' perceptions of WBAs during clerkships, using a strengths-based approach to envision an ideal WBA system.
Methods
We organised six focus groups (N = 24) guided by Appreciative Inquiry. Focus group discussions focused on memorable assessment experiences, underlying values, desired changes and visions of an ideal system. We used Reflexive Thematic Analysis within a constructionist paradigm through iterative coding, thematic mapping, analytic memos and team discussions to ensure rigour and reflexivity.
Results
Three themes represent foundational conditions for an ideal WBA system: (1) Being seen, acknowledging students as individuals through personalised feedback; (2) Growth, conceptualising WBAs as a longitudinal process supporting learning and career exploration; and (3) Feeling safe, emphasising a meaningful dialogue and a culture of trust. A fourth theme, Balancing ideals, captured the inherent tensions between competing ideals. Importantly, students perceived assessment as trustworthy not when subjectivity was eliminated but when it was considered accountable and conducive to fair outcomes.
Discussion
Our findings suggest that trustworthy WBA systems are best understood as sets of deliberate compromises, negotiated in ongoing dialogue with students and assessors, rather than one-size-fits-all frameworks. By adopting a strengths-based approach, this study reframes familiar assessment concepts as conditions for enabling trust, rather than as solutions to deficits. These findings advance our understanding of how to embed subjectivity into WBAs in a trustworthy manner and offer a student-informed approach for strengthening WBAs design in undergraduate medical education.