How Are Workplace-Based Formative Assessments Used for Making Summative Decisions?

Objectives: Limited evidence is available on how postgraduate dental assessment systems incorporate formative assessments (FA) of trainees' performance into summative decisions (SD). This study explored how clinical supervisors use FAs to make summative progress decisions and how trainees perceive this process.
Methods: Data were collected through focus group and semi-structured interviews of 16 postgraduate dental trainees and 8 supervisors representing five specialties at a single institution in the United Arab Emirates in 2023-2024. A topic guide was used to explore users’ perceptions and experiences regarding the SD processes. The inductive qualitative data analysis followed Braun and Clarke’s six-step reflexive thematic analysis.
Results: The interpretation of 'who is competent?' was characterized by trustworthiness and the ability to provide independent, high-quality patient care. Participants indicated lack of pre-defined standards, limited understanding of the assessment system, and implementation issues as main challenges of relying on FA information. Suggestions to enhance WBAs credibility for SD involved calibrating assessors, utilizing a digital platform with visual displays of trainees’ progress, encouraging users’ engagement, improving assessment items, and simplifying WBA tools.
Sources of information for summative competence judgment included supervisors’ consensus, WBAs portfolio, and summative case-based oral exams. Perceived ambiguity, biases, and the blurring relation between FA and SD were highlighted among the difficulties in making summative decisions. The FA data proved useful in identifying underperforming trainees and facilitating the provision of necessary support. However, confidence in backing summative decisions to fail was hindered by insufficient reliable information.
Conclusions: The use of a multisource, properly implemented WBA e-portfolio would enhance data synthesis and minimize biases during summative consensus meetings. Inadequate or unreliable FA data leads supervisors to rely on recall for SD, resulting in less justifiable decisions, especially in cases of underperformance.