Development and application of a Workplace-Based Assessment (WPBA) instrument based on competency for medical internship

BACKGROUND: Competency-Based Medical Education (CBME) is crucial to prepare future physicians for independent clinical practice. Professionalism is a core competency, yet its definition and assessment remain a challenge in medical education. This study describes the development of an instrument based on competencies for Workplace-Based Assessment (WPBA) and its application to medical interns at the University of São Paulo, one of the leading medical schools in Brazil. METHODS: The instrument was developed based on established frameworks (ACGME Milestones, CanMEDS, the RIME model and Bloom's taxonomy) and validated using a Delphi consensus strategy with 64 experts. The instrument comprises six domains (Communication/Collaboration/Interpersonal Skills, Professionalism, Patient Care, Applied Knowledge, Health System, and Self-Development). We applied this instrument to assess 344 fifth and sixth-year medical students during clinical rotations from August 2024 to June 2025. We assessed internal consistency with Cronbach's alpha and conducted descriptive analyses to investigate overall academic performance correlates of the competency-based assessment scores. RESULTS: The assessment instrument demonstrated high internal consistency (α = 0.97). Significant correlations (P < 0.001) were found between most competencies, with a strong correlation between the professionalism and patient care domains, confirmed by Bland-Altman analysis. There were 53 interns (15%) who received at least one rating of 'unacceptable' or 'below expectations' in professionalism. Students rated 'below expectations' in reliability in task completion demonstrated significantly worse performance in the patient care domain compared to those rated 'satisfactory' or 'excellent'. CONCLUSIONS: This study presents a comprehensive, competency-based Workplace-Based Assessment (WPBA) instrument with initial sources of validity evidence, which helps identify the strengths and weaknesses of medical interns, particularly in the complex domain of professionalism.

Competency assessment · Curriculum · Educational measurement · Internship · MEDLINE · Innovations in Medical Education · Simulation-Based Education in Healthcare · Surgical Simulation and Training