Strengthening formative assessments in psychiatry: curriculum alignment, entrustability and improved workplace-based assessments

AIMS AND METHOD: Concerns have been raised regarding the UK psychiatry curriculum (2022) relating to variability in workplace-based assessment (WBPA) and to the assessment of the autonomy, formulation skills and non-clinical competencies of resident doctors in training. The Royal College of Psychiatrists established a Formative Assessment Working Group with four Task and Finish Groups comprising resident doctors in training, trainers, educational leaders, patients and carers. Stakeholder consultation, educational literature, psychometric evidence, cross-specialty benchmarking and iterative consensus-building informed the resulting recommendations. RESULTS: A five-point entrustability scale was introduced in end-of-placement reports to support judgements of the autonomy of resident doctors in training. A simplified WBPA rubric replaced the previous Likert scale. Formulation was embedded explicitly within case presentations, and structured patient and carer feedback was incorporated into portfolios. Direct observation of non-clinical skills was expanded to assess leadership, public mental health and system-level competencies aligned with curriculum's High Level Outcomes. CLINICAL IMPLICATIONS: The reforms enhance consistency of supervision, strengthen clinical reasoning and reflective practice, and improve alignment between assessment, curriculum outcomes and consultant-level responsibilities without increasing overall assessment load.