The introduction of workplace-based assessment into postgraduate medical training in South Africa: trainee perspectives

Abstract

South Africa (SA) is moving towards implementing workplace-based assessments (WBA) in all medical specialist training programmes in the country. There are many challenges with implementing WBA, with existing literature suggesting implications for resources, and recognizing regulatory, educational, and social complexities. Research on WBA practices, experiences, and perceptions in the SA healthcare system is limited. The aim of this study was to identify factors that could impact WBA implementation from the perspectives of medical doctors in SA undergoing medical specialist training. The findings report on the perspectives, aspirations, and concerns of these postgraduate medical specialist trainees (also known as registrars and residents). This paper reports on the qualitative data generated from a longitudinal mixed methods study that employed focus group discussions (FGDs) to gather data at different points in time of WBA implementation. We conducted two phases of institution-specific, interdisciplinary FGDs at seven universities in two phases. FGDs typically included between 6 and 10 trainees, lasted 60 min, and were facilitated online by a sociologist (ED). Sessions were audio-recorded and transcribed verbatim. Data were analysed thematically and inductively. Six themes were identified from the data. Trainees had a generally positive attitude towards WBA in theory. However, they expressed anxieties about supervisor bias, unequal clinical contexts, and lack of standardization affecting their assessment outcomes if WBA was to be fully implemented. They reported that consultants were often unavailable for WBA activities and misunderstood the differences between summative and formative assessments. Trainees support WBA in principle but anticipate uneven implementation without structured faculty development, protected observation time, and safeguards for fairness across settings. Early implementation should prioritize role clarity, feedback skills, and context-sensitive quality assurance.