HY So, LCN Chan, HS Lam, AKM Chan, WYK Chan, JCY Chow, KY Yeung, FWT Cheng

Abstract

Introduction: The Hong Kong College of Paediatricians launched workplace-based assessment (WBA) in July 2025 as part of its transition to competency-based medical education. To support this reform, the College conducted its first WBA trainer workshop in May 2025. This study evaluates the workshop's effectiveness in enhancing trainer readiness and explores implications for system-wide implementation. Methods: A mixed-methods design was adopted. Quantitative data were collected from 16 trainers using the CPD-Reaction Questionnaire, grounded in the Theory of Planned Behaviour and Triandis' theory, to measure changes in perceived capability, beliefs about consequences, moral norm, and social influence. Paired t-tests assessed pre-post differences. Post-workshop focus groups with 13 trainers were analysed thematically. Results: Quantitative analysis demonstrated a statistically significant increase in perceived capability (p<0.001). No significant changes were found in other domains, with high baseline scores suggesting ceiling effects. Qualitative analysis yielded four key themes: (1) educational drivers, including structured WBA frameworks, experiential learning, and peer-assisted learning; (2) determinants of intention to participate, including enhanced capability, perceived consequences, moral motivation, and lack of peer reinforcement; (3) unaddressed practical challenges; and (4) emergent system-level barriers, including trainee readiness, variation in trainer preparedness, time constraints, and the need for structured rollout planning, intercollegiate collaboration, and electronic documentation platforms. Conclusion: The workshop effectively strengthened trainer capability and surfaced implementation challenges requiring attention. Further progress will depend on longitudinal faculty development, trainee engagement through feedback literacy, supportive infrastructure (including an electronic platform), and strategies to build a critical mass of trained faculty aligned with Rogers' Diffusion of Innovations framework.

Introduction

Workplace-based assessment (WBA) is a core feature of competency-based medical education (CBME), offering trainees formative feedback grounded in observed clinical performance. It is intended not merely as an assessment tool, but as a means to foster clinical learning by promoting feedback-driven development.^1,2 Despite this promise, implementing WBA remains challenging. Many training systems report inconsistent adoption, low trainer engagement, and superficial feedback. A key barrier lies in the readiness and capability of clinical educators to deliver WBA effectively.^3,4

These difficulties often stem from a gap between what WBA is intended to achieve and what clinical trainers feel equipped to deliver. As Steinert and colleagues note, meaningful innovation requires more than procedural compliance: it involves shifts in professional identity, beliefs, and relationships.⁵ For trainers accustomed to summative assessment and didactic teaching, feedback has often been directive, focused on instruction rather than developmental dialogue. WBA introduces new expectations: observing performance, offering timely feedback, and cultivating psychologically safe environments.⁶ This shift is neither automatic nor intuitive, especially without robust faculty development to support behavioural and cultural change.

In Hong Kong, the Hong Kong Academy of Medicine (HKAM) has endorsed CBME, and the Hong Kong College of Paediatricians (HKCPaed) began formal rollout of WBA in 2025.⁷ As one of the largest constituent Colleges, HKCPaed faces the dual challenge of building trainer capability and promoting culture change across a diverse network. To support this, the College organised a full-day trainer workshop in May 2025, combining asynchronous e-learning with face-to-face experiential learning.

This study evaluates that initiative. Using a mixed-methods approach, we examined whether the workshop influenced trainers' intention and perceived capability to participate in WBA. Quantitative data were collected using the CPD-Reaction Questionnaire, grounded in the Theory of Planned Behaviour and Triandis' theory.^8,9 We also explored participants' perceptions of the training, including perceived value, challenges, and anticipated barriers to applying WBA.

While prior studies highlighted the importance of faculty development for CBME, few have examined its early impact on WBA adoption in a large, generalist specialty.¹⁰ By focusing on paediatric trainers, this study addresses a practical gap and responds to the call for more context-sensitive research.

These findings can guide faculty development and help embed WBA into routine training by identifying key enablers, barriers, and readiness gaps. They may also support HKCPaed and other Colleges in implementing CBME more sustainably.

Specifically, this study addressed the following research questions:

1. Does participation in the trainer workshop influence participants' intention to engage in WBA and their perceived capability to do so?

2. How do participants perceive the value and relevance of the trainer workshop, and what challenges do they anticipate in applying their learning to real-world training contexts?

Method

Setting and Participants
This study was conducted within the postgraduate training framework of the HKCPaed, one of 15 Colleges under the HKAM. In preparation for WBA rollout in July 2025, HKCPaed launched a structured faculty development programme. The College oversees around 300 accredited trainers supervising paediatric trainees across a six-year programme. Each year, 20-30 new trainees enter training delivered across 14 accredited units. For the inaugural WBA workshop in May 2025, each unit was invited to nominate two trainers. Nineteen trainers enrolled and were invited to join this voluntary evaluation study. All were practising paediatricians involved in training.

Instruction Design
The initiative comprised two linked components. First, an 80-minute asynchronous e-learning module introduced CBME principles, the rationale for and procedures of WBA, as well as foundations of effective feedback.

Second, a full-day, in-person workshop emphasised experiential learning.¹¹ It began with short interactive lectures activating participants' knowledge of the six steps of WBA framing the process of workplace-based learning. Psychological safety was addressed explicitly using strategies adapted from Rudolph et al, including a structured pre-brief at the start of the workshop to set expectations and foster a safe learning environment.¹² Participants then engaged in live demonstrations and immersive role-plays using clinical scenarios. They rotated through the roles of assessor, trainee, and observer, with each encounter followed by structured debriefing to support reflection and peer learning. Participants practised three core WBA tools: DOPS, Mini-CEX, and CbD. While MSF was introduced conceptually but not practised due to time and format constraints.

Data Collection and Analysis
Quantitative Evaluation

Participants completed the Continuing Professional Development-Reaction (CPD-Reaction) Questionnaire pre- and post-workshop. This validated instrument, grounded in the Theory of Planned Behaviour and Triandis' Theory, measures behavioural intention and its cognitive and social determinants: perceived capability, beliefs about consequences, moral norm, and social influence.^8,9 Responses used 7-point Likert scales. Domain scores were calculated by summing items, with max scores varying by domain. The Shapiro–Wilk test assessed normality of difference scores. Pre-post differences were evaluated with paired-sample t-tests; effect sizes used Cohen's d. Analyses were conducted using Jamovi (version 2.6.26.0).

Qualitative Evaluation
Focus groups were held immediately post-workshop. Thirteen of 19 participants joined one of two focus groups (approx. 45 minutes each). Conducted in Cantonese and moderated by staff from the Hong Kong Jockey Club Institute of Medical Education and Development (JCIMED), who were not workshop facilitators, this minimised social desirability bias. A semi-structured guide explored workshop relevance, value, applicability, anticipated barriers, and support needs. Sessions were audio-recorded, transcribed verbatim, and anonymised.

Data were analysed using reflexive thematic analysis following Braun and Clarke's six-phase approach.¹³ Two researchers (HS and LC) independently coded transcripts, discussed codes, resolved discrepancies, and identified themes. Themes were refined iteratively to ensure clarity and relevance. NVivo (version 14) supported coding and development. An audit trail was maintained to enhance trustworthiness.

Member Checking
To enhance credibility, we conducted member checking post-analysis. A summary of the themes and subthemes was shared via email with all focus group participants, who could review and comment anonymously.

Reflexivity
This study was conducted by a multidisciplinary team with varied roles in the workshop and CBME reform, which shaped both its design and interpretation. HS is the Educationist of the HKAM and lead designer of the workshop. A specialist in anaesthesiology and intensive care with prior leadership in quality and safety, he contributed both educational and clinical perspectives throughout the research process. LC, a paediatrician and Assistant Educationist of HKAM, was responsible for aligning CBME implementation in the HKCPaed with HKAM's strategic direction. His familiarity with the College's internal dynamics supported the contextual interpretation of trainer feedback. HSL, also a paediatrician and HKCPaed trainer, has been actively involved in the transition to CBME within the College and teaches in its new paediatric-specific medical education courses. His insights helped bridge participant comments with curriculum design realities. FC, Chairman of the Faculty and Curriculum Development Committee of HKCPaed, is the key driver of WBA implementation within the College. His leadership role informed both strategic framing and feasibility considerations. AC, a consultant anaesthetist with a Master's in Health Professions Education and Chair of the Training and Faculty Development Subcommittee at JCIMED, contributed to the instructional design, drawing on his educational expertise. WC, JC, and KY are HKCPaed trainers and workshop faculty who contributed to planning and delivery and brought practical insight into trainer engagement and implementation barriers.

Ethics
Ethical approval was granted by the Survey and Behavioural Research Ethics Committee of The Chinese University of Hong Kong. Written informed consent was obtained (SBRE-24-0737), and all data were anonymised.

Results

Quantitative Findings
Of the 19 trainers who attended the workshop, 16 completed both pre- and post-workshop CPD-Reaction questionnaires and were included in the quantitative analysis. As shown in Table 1, there was a statistically significant increase in perceived capability, with mean scores rising from 9.44 (SD=2.11) to 11.31 (SD=1.79) (p<0.001, Cohen's d=-1.077), indicating a large effect size.

In contrast, no statistically significant changes were observed in the other domains. Mean scores for beliefs about consequences increased slightly from 11.00 (SD=2.37) to 11.38 (SD=1.59) (p=0.202, Cohen's d=-0.215), and for moral norm from 11.13 (SD=1.71) to 11.38 (SD=2.03) (p=0.326, Cohen's d=-0.115). Social influence showed negligible change.

Qualitative Findings
Thirteen of the 19 workshop participants took part in post-workshop focus groups. Thematic analysis identified four overarching themes and related subthemes, illustrating how trainers perceived the workshop's value, the factors influencing their intention to engage in WBA, and the systemic enablers and constraints surrounding implementation. These themes are summarised in the thematic map (Figure 1). Illustrative quotes are presented below in Cantonese with English translations and participant codes.

Figure 1 Thematic Map.

Member checking was conducted by sharing a thematic summary with all 19 participants. Seven participants (37%) responded. Their feedback affirmed that the analysis resonated with their experiences; no new themes were identified and no major revisions were required. Respondents also rated the accuracy and relevance of each subtheme on a 5-point scale. The average ratings ranged from 3.4 to 4.6, indicating overall agreement with the findings. Table 2 presents the themes, subthemes, and corresponding ratings.

Theme 1: Educational Drivers
1.1 Structured Procedural Framework
Participants noted that the six-step framework for WBA offered a systematic, structured approach to delivering feedback and helped them internalise a clearer process for guiding trainee development.

「比起平時我們想幫trainee的那個意願是沒有分別的…但比返一個framework，明白每一個做的一些東西，怎樣去幫助那個trainee。」

"Compared with before, our willingness to help trainees hasn't changed… but giving us a framework helps us understand each step and how it supports the trainee." (FG1 P3)

1.2 Experiential Learning Deepens Understanding
Experiential learning through role-play and debriefing, in a safe environment, was essential for skill development. Trainers could practise, receive feedback, and gain insights into their own behaviours.

「我們今天就好像trainee一樣，去學習被人看，但我們都覺得safe的，去被人看，然後再學到一些東西。」

"Today, we were like trainees, learning while being observed, but we all felt safe being observed and learnt from it." (FG1 P3)

1.3 Peer Interaction Normalises Practice and Builds Motivation
Observing and interacting with peers helped trainers learn effective practices and feel motivated. Feedback from colleagues made the experience supportive and enriched their learning.

「觀察同學一起做的時候…學到很多技巧。」

"Watching other participants doing it… I learnt a lot of techniques." (FG2 P5)

Theme 2: Determinants of Intention to Participate
This theme explores psychological and social influences on WBA adoption. Findings reflected constructs in the CPD-Reaction Questionnaire.

2.1 Perceived Capability Enhanced Through Practice
The workshop improved trainers' confidence through structured, hands-on exercises. Practising with authentic tools and scenarios helped trainers feel more prepared to conduct WBA in real settings.

「我們的信心增加了很多，我們覺得那個 role play 是非常之有用的。」

"Our confidence increased a lot. We felt that the role play was extremely useful." (FG2 P9)

2.2 Beliefs About Consequences: Recognising Educational Value Amid Practical Constraints
Trainers recognised that WBA could improve feedback quality and support trainee development, marking a shift from checklist-based assessment to constructive learning dialogues. However, practical barriers such as time pressure and unfamiliarity with tools remained.

「如果有這樣的guide，我認為learning process和進步應該是很positive的。」

"If there were such a guide, I believe the learning process and progress would be very positive." (FG1 P6)

2.3 Moral Motivation and Professional Identity
Many saw WBA as part of their professional obligation. They believed trainers should model and promote good assessment practice.

「我哋都係trainer，有責任教人，呢個係我哋嘅角色。」

"We're trainers-it's our responsibility to teach. That's part of our role." (FG2 P6)

2.4 Social Influence: Limited Peer Norms and Isolation in Practice
While trainers valued institutional support and recognised the need to align with College expectations, many noted a lack of shared norms and coordinated practices within their units. Some felt isolated in implementing formative assessment, as colleagues were often disengaged or unsure how to contribute. The absence of peer modelling weakened collective momentum.

「譬如我那裡只有我一個上完，其他trainer又不懂，那又如何推呢？」

"For example, I'm the only one from my place who attended. If the other trainers don't understand it, how can we push this forward?" (FG1 P8)

Theme 3: Unaddressed Practical Challenges
Some participants expressed while CbD was practised, the case scenario lacked realism, reducing its practical value. Multi-Source Feedback (MSF) was introduced conceptually but not practised. In addition, participants noted the absence of explicit guidance on documentation procedures, including how to complete assessment forms efficiently and meaningfully. This gap left some trainers uncertain about applying the tools confidently and consistently in clinical settings.

「不過都是覺得documentation那裡沒有講太多的，希望講多一點。」

"But I felt the part about documentation wasn't really covered much-I hoped there would be more explanation." (FG1 P9)

Theme 4. Emergent System-Level Barriers
Participants identified structural barriers to implementation.

4.1 Trainee Readiness and Engagement
Participants noted that effective implementation of WBA also depends on trainees' understanding of its purpose and their ability to engage meaningfully.

「如果我是一個trainee的話，其實由一個舊的system，即是由一個 summative 去一個 formative ，其實我覺得可能要多些materials。」

"If I were a trainee, transitioning from the old system-that is, from a summative to a formative one-I think I would probably need more materials." (FG1 P7)

4.2 Trainer Capability and Cultural Readiness
Some participants emphasised that applying its approaches in real settings requires time, support, and ongoing development. They called for structured train-the-trainer resources, including specialty-specific videos and scripted guides, to support consistent adoption.

「現在上完之後就瞭解多了，但也擔心真的要做下來，其實都會有些困難，回去告訴同事聽，其實都會有些難度。」

"After completing the workshop, I understand much more, but I still worry that actually doing it will be difficult. Even just going back and explaining it to colleagues might be challenging." (FG2 P7)

4.3 Need for Structured Rollout and Intercollegiate Sharing
Several trainers expressed concern about the absence of a clear, coordinated rollout plan and the short timeframe for implementation which may affect the consistency and sustainability of WBA. Beyond local implementation, some participants also highlighted the need for alignment and knowledge sharing across Colleges.

「因為現在其實都很趕，只剩下兩個月時間，要開始行。」

"Right now, everything feels rushed-we only have two months left before we start." (FG1 P4)

「覺得有些colleges已經在run緊，我覺得他們可以給我們多一些實際的經驗 sharing，甚至是一個real life example讓我們看著。那我們就可以有多一些想像到會發生甚麼事」

"I feel that some Colleges are already running [WBA]. I think they could share more practical experience with us-maybe even give us a real-life example to observe. That way, we could better imagine what's actually going to happen." (FG2 P3)

4.4 Electronic Tools to Support Implementation
Some participants suggested that automated features and integrated tracking systems of electronic platforms could improve efficiency and reduce manual follow-up.

「可不可以像現在的那些electronic record，我又可以容易地trace到trainee在做什麼，不用每次要我自己親自去追，我覺得用electronic method可能是長遠的想法。」

"Could it be like the current electronic records? Then I could easily trace what trainees are doing without having to follow up manually each time. I think using an electronic method might be a more sustainable approach." (FG1 P7)

4.3 Time Constraints and Workflow Integration
Many participants described difficulty integrating WBA into busy clinical environments. Competing service demands and a lack of protected time were major barriers to consistent use.

「我想最實際就是時間。因為用多了時間。那怎樣跟trainee配合時間，怎樣去預備呢？ 」

Discussion

This mixed-methods evaluation of the first WBA trainer workshop conducted by the HKCPaed offers valuable insights into how targeted faculty development may support the implementation of CBME reforms. The evaluation was guided by an integrated model of behaviour change, drawing on the Theory of Planned Behaviour (TPB) and Triandis' Theory of Interpersonal Behaviour, as operationalised in the CPD-Reaction Questionnaire.8,9 This framework posits that a trainer's behavioural intention-central to implementing WBA - is shaped by four main constructs: perceived capability, beliefs about consequences, perceived social influence, and moral norm. Our findings suggest that the workshop enhanced trainers' perceived capability and reinforced moral motivation, while also surfacing practical concerns and contextual barriers related to social influence and implementation feasibility.

The results suggest that the workshop was effective in preparing trainers for their role in WBA. Quantitative data showed a significant increase in perceived capability, and this was corroborated by qualitative findings in which trainers described enhanced confidence and clarity in conducting feedback conversations. The workshop format, structured, interactive, and psychologically safe, was frequently cited as an enabling factor. These findings suggest that experiential training, consistent with principles of adult learning and Kolb's experiential learning cycle, can help trainers shift from didactic, summative assessment traditions to a more formative, coaching-oriented mindset, even within time-constrained clinical environments.^11,14

For the domains of beliefs about consequences and moral norm, the lack of statistically significant change was likely attributable to relatively high baseline scores, which may have constrained the potential for measurable improvement. Specifically, participants reported pre-workshop mean scores of 11.00 (SD=2.37) for beliefs about consequences and 11.13 (SD=1.71) for moral norm, on a scale with a maximum of 14. These figures suggest that participants already held strong convictions about the value of WBA and their moral responsibility to engage in its implementation. While not necessarily indicative of strict ceiling effects in the psychometric sense, these elevated starting points may have limited the observable gain. This interpretation is reinforced by qualitative findings, which pointed to strengthened appreciation of WBA's formative purpose and a renewed sense of professional obligation, changes that may not have been fully captured by the CPD-Reaction instrument. Importantly, this discrepancy may reflect a response shift bias, where participants recalibrate their internal standards after gaining a deeper understanding of the construct, leading to underestimation of change when using traditional pre-post measures.^15,16 This pattern does not suggest a shortcoming of the instrument itself, but rather reflects the characteristics of the participant cohort, which comprised individuals who were either self-selected or nominated based on their roles in education, such as training supervisors, and who may have been particularly motivated or aligned with the goals of the workshop from the outset.

The social influence domain remained both quantitatively unchanged and qualitatively problematic. Participants noted that few of their colleagues had attended similar training, and that trainees had not yet been oriented to WBA. These factors created a perceived lack of shared understanding and peer reinforcement, making it difficult to translate workshop learning into practice. Within the TPB framework, social influence (akin to subjective norm) reflects perceived expectations from colleagues and the broader institutional culture.¹⁷ A gap in this domain indicates that the trainers' work environment lacked the critical mass, role modelling, and psychological safety necessary to normalise formative assessment conversations.4 This aligns with findings from other implementation research, which highlight that isolated training initiatives are insufficient unless supported by peer uptake, leadership endorsement, and cultural reinforcement within the clinical setting.¹⁸ Without visible engagement from colleagues or adequate trainee preparedness, even capable and motivated trainers may feel disempowered to enact change.

Importantly, the workshop did more than increase individual capability - it triggered deeper critical reflection on the system-level requirements for successful WBA implementation. Trainers highlighted a range of persistent issues: lack of trainee readiness, limited reach of faculty development, and structural constraints such as insufficient time and documentation burden. Rather than responding with frustration, participants appeared to adopt a more systemic perspective, recognising that effective WBA implementation requires coordinated action across multiple roles and levels. This shift aligns with O'Sullivan and Irby's proposition that faculty development should be reframed not merely as a means to transfer skills, but as a catalyst for deeper professional inquiry and organisational learning.¹⁹ The workshop thus functioned not only as a training event, but also as a site of sense-making, in which trainers reconceptualised their roles and responsibilities within a broader educational reform effort.

These findings point to the centrality of faculty development, not as a standalone intervention, but as a gateway to broader institutional change.¹⁹ A well-designed workshop can empower individual trainers, surface contextual barriers, and engage frontline educators as active contributors to implementation strategy. This aligns with the Consolidated Framework for Implementation Research (CFIR), which underscores that successful implementation depends not only on individual knowledge and beliefs but also on characteristics of the intervention, the inner and outer settings, and the implementation process.²⁰ In this light, faculty development becomes a mechanism through which institutional priorities are operationalised, frontline insights are channelled into system design, and the cultural groundwork for sustainable assessment reform is laid.

Way Forward
There are several implications from these findings. First, to sustain and scale the impact of the WBA trainer workshop, broader diffusion is required. In the short term, the College could expand workshop coverage to a wider cohort of trainers, aiming to build the critical mass necessary to normalise formative assessment practices. Rogers' Diffusion of Innovations theory offers a useful lens for understanding this strategy.²¹ With 19 out of 300 trainers (~6%) participating in the first wave of workshops, the College has begun to engage the innovators and some early adopters. However, reaching the early adopter threshold, typically around 16.7%, is critical for crossing the so-called "chasm" that separates early adopters from the early majority. Achieving this tipping point will require strategic efforts to leverage early successes, visibly demonstrate WBA's practical value and feasibility, and embed these practices into everyday clinical routines. Only through visible reinforcement, peer modelling, and alignment with service delivery can a meaningful cultural shift be cultivated across the specialty.

Crucially, faculty development must grow not only in reach but also in depth. A single workshop, while effective in catalysing initial change, is unlikely to sustain long-term behavioural transformation. As Steinert and colleagues emphasise, meaningful development requires longitudinal engagement, where trainers iteratively practise new behaviours, receive feedback, and reflect on their teaching over time.¹¹ Participants in this study echoed this principle, highlighting the need for deeper coverage of tool-specific applications (e.g., CbD), earlier introduction of underused tools (e.g., MSF), and more concrete guidance on documentation. Future workshops should thus be part of a structured developmental continuum, with opportunities for progressive skill-building, peer exchange, and situated learning within clinical teams. This aligns with calls in the faculty development literature to reframe workshops not as isolated interventions, but as gateways into communities of practice and reflective teaching.¹⁹

Second, trainer capability is a necessary but insufficient condition for successful WBA implementation. Trainee readiness emerged as a parallel prerequisite. Trainers in this study frequently described a lack of trainee understanding about their roles in formative assessment, which undermined efforts to engage in meaningful feedback interactions. Bridging this gap requires intentional, trainee-facing strategies-such as structured orientation to WBA processes and explicit development of feedback literacy. Feedback literacy involves not only the ability to receive and interpret feedback but also to make evaluative judgements and take action to improve performance.²² Carless reminds us that effective feedback is inherently dialogic: it requires mutual sense-making and active learner agency.²³ To foster this, both trainers and trainees must be supported to reconceptualise feedback not as evaluative judgement, but as an ongoing, co-constructed learning process. When both parties are aligned in purpose and practice, WBA can function as a generative and sustainable educational tool.

Third, system-level enablers play a crucial role in translating individual capability into sustainable practice. For example, a user-friendly electronic platform or e-portfolio can streamline WBA documentation and promote continuity of feedback across clinical contexts and over time.²⁴ However, the mere presence of technology is insufficient. To be effective, these tools must be embedded within a broader faculty development strategy that equips trainers with the confidence and skills to use them purposefully. When aligned with educational goals, digital platforms can reduce administrative friction and reinforce formative assessment principles. Conversely, if poorly implemented, they risk becoming an additional burden or reverting feedback practices to checklist-driven compliance.

Finally, persistent structural barriers, particularly time constraints, must be confronted if WBA is to be sustainably implemented. Trainers repeatedly highlighted that heavy clinical workloads curtailed their capacity to engage meaningfully in formative assessment, even when they were well-intentioned and adequately trained. Addressing this issue requires more than individual adaptation; it demands institutional commitment. Hospital administrators, department leaders, and workforce planners must be engaged to explore models that integrate WBA into clinical workflow, rather than positioning it as an additional task.²⁵ Embedding formative assessment within service delivery-through strategies such as protected time, workload redistribution, or team-based feedback approaches-is essential to realising the promise of competency-based education.

Limitations

This study has several important limitations. First, participation in both the workshop and its evaluation was voluntary, introducing the potential for selection bias. A notable proportion of participants (37%) held training supervisor roles, representing half of all paediatric training unit supervisors in the locality. This may have significantly influenced engagement and responses. Given their leadership responsibilities, these individuals may have felt an institutional obligation to attend, either due to direct involvement in assessment practices or perceived expectations to champion educational reforms. This sense of duty could have led to overrepresentation of participants who were already more receptive to WBA, while those less engaged or sceptical may have opted out. Moreover, the nomination process, which allowed up to two participants per training unit, may have inadvertently compounded this bias. Unit directors selecting attendees might have prioritised supervisors or motivated educators, further skewing the sample toward individuals with pre-existing enthusiasm for WBA. The findings may therefore reflect the perspectives of a particularly invested subgroup rather than the broader community of clinical educators, limiting generalisability.

Second, the sample size was relatively small and drawn from a single specialty college, which may limit the transferability of findings to other contexts or disciplines.

Third, while the CPD-Reaction instrument is theoretically grounded and psychometrically validated, its ability to detect change may have been influenced by relatively high baseline scores in certain domains, particularly beliefs about consequences and moral norm. Although these pre-intervention scores were not at ceiling, they may have left limited headroom for measurable improvement. These elevated starting points likely reflect the nature of the cohort, comprising committed educators rather than a broader cross-section of frontline clinicians. Finally, although the qualitative data enriched interpretation, the absence of longitudinal follow-up limits our understanding of whether the reported changes in perception and intention translate into sustained behaviour change in clinical practice.

Conclusion

This evaluation of the inaugural HKCPaed WBA trainer workshop underscores the catalytic potential of targeted faculty development in advancing CBME. Drawing on both quantitative and qualitative evidence, the findings demonstrate that even a single, thoughtfully designed workshop can enhance trainer capability, foster confidence in formative feedback, and prompt deeper reflection on system-level conditions necessary for effective implementation. While measurable improvements were limited in domains with high baseline scores, namely moral norm and beliefs about consequences, the qualitative data revealed meaningful shifts in mindset and professional identity.

Crucially, faculty development should be viewed not merely as an educational intervention, but as a strategic lever for institutional reform. When faculty are engaged as active participants in the change process, they become powerful agents of cultural transformation. This evaluation highlights several priority areas for action: refining workshop content to address identified gaps; providing longitudinal development pathways to reinforce behavioural change; explicitly supporting trainee readiness through feedback literacy initiatives; and enabling system-wide integration through technological and administrative supports.

As the College moves toward the formal implementation of WBA in July 2025, these insights offer a practical, context-sensitive roadmap for scaling and sustaining reform. Ultimately, successful CBME implementation depends not only on individual capability, but on the coordinated alignment of people, processes, and structures-with faculty positioned as core partners in this transformation.

Funding

This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Conflicts of Interest

The authors declare no conflicts of interest.

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