Document Type : Review
M.Sc. in Entomology, Instructor of Biology Dept., School of Basic Sciences, Imam Hossein (as) University, Tehran, Iran
General Practitioner & M.Sc. in Medical Education, Medical Education Assessment Center, Ministry of Health and Medical Education, Tehran, Iran
Background: Assessment of clinical competencies is one of the complicated and hard tasks in medical education Nowadays assessment of clinical performance is significantly patient centered and student centered Traditional methods consisted of faculties observations oral examinations and multiplechoice tests Increased faculties workload discontent with traditional methods of clinical skill assessment and developments in the fields of psychology and education have led to the formation of new modalities in performance assessment methods with special definition Clinical competency is defined as the ability to gather information from the patient by history taking and physical examination integrating this information in order to make a diagnosis selecting appropriate laboratory tests to confirm the diagnosis and efficient disease management At the present time several fields for future direction of performance assessment in medical education are suggested including: a) Evidencebased locally developed assessments b) Understanding educational outcomes and noncognitive assessment factors c) Increase in studentdriven aspect of assessments Attempting to introduce new and advanced medical students clinical performance assessment methods according to the world accredited centers this article analyzed three mentioned directions in field of clinical performance assessment Conclusion : Improvement of performance assessment in local or national level is a complex issue which needs time cooperation recourses and fundamental attempts However this is the price to pay if we believe that clinical competency can improve quality of patient care
- Schuwirth LW, Van der Vleuten CP. Challenges for educationalists. BMJ 2006; 333(7567): 544-6.
- Howley LD. Performance assessment in medical education. Eval Health Prof 2004; 27(3): 285-303.
- Fraser SW, Greenhalgh T. Coping with complexity: educating for capability. BMJ 2001; 323(7316): 799-803.
- Lake FR. Teaching on the run tips 9: intraining assessment. Med J Aust 2005; 183(1): 33-4.
- Deal TB, Courtney K, Rousseve J, Miller P, Lang D, Call JM. Health education assessment project: SCASS-HEAP steering committee guidelines for the HEAP distance learning initiative; September 2005. Available from:URL:http://www.ccsso.org/projects.
- General Medical Council. Tomorrow’s Doctors: Recommendations on Undergraduate Medical Education .London: GMC; 1993.
- General Medical Council. Tomorrow’s Doctors: Recommendations on Undergraduate Medical Education .London: GMC; 2003.
- LCME Liaison Committee on Medical Education; 2003. Available from: URL: http://www.lcme.org.
- Newble D, Jolly B, Wakeford R. The certification and recertification of doctors: issues in the assessment of clinical competence. Cambridge University Press. BMJ 1994; 309: 1096.
- Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA 2002; 287(2): 226-35.
- Batalden P, Leach D, Swing S, Dreyfus H, Dreyfus S. General competencies and accreditation in graduate medical education. Health Aff (Millwood) 2002; 21(5): 103-11.
- Leung WC. Competency based medical training: review. BMJ 2002; 325: 693-6.
- Harden RM, Gleeson FA. Assessment of clinical competence using an objective structured clinical examination (OSCE). Med Educ 1979; 13(1): 41-54.
- The University of Auckland, faculty of medical and health sciences. Available from: URL: http:// www. health. auckland.ac.nz.
- Committee on quality of health care in America. Crossing the quality chasm: a new health system for the 21st century. Institute of medicine, Washington, D.C.: National Academy Press, 2001: 12.
- Ginsburg S, Regehr G, Lingard L. Basing the evaluation of professionalism on observable behaviors: a cautionary tale. Acad Med 2004; 79(10Suppl):S1-4.
- Schirmer JM, Mauksch L, Lang F, Marvel MK, Zoppi K, Epstein RM, et al. Assessing communication competence: a review of current tools. Fam Med 2005; 37(3): 184-92.
- Epstein RM, Dannefer EF, Nofziger AC, Hanse JT, Schultz SH, Jospe N, et al. Comprehensive assessment of professional competence: the Rochester experiment. Teach Learn Med 2004; 16(2): 186-96.
- Van der Vleuten CP. The assessment of professional competence: developments, research and practical implications. Adv Health Sci Educ 1996; 1:41-67.
- Van der Vleuten CP, Norman GR, De Graaff E. Pitfalls in the pursuit of objectivity: issues of reliability. Med Educ 1991; 25(2): 110-8.
- Norman GR, Van der Vleuten CP, De Graaff E. Pitfalls in the pursuit of objectivity: issues of validity, efficiency and acceptability. Med Educ 1991; 25(2): 119-26.
- Colliver JA, Vu NV, Barrows HS. Screening test length for sequential testing with a standardized-patient examination: a receiver operating characteristic (ROC) analysis. Acad Med 1992; 67(9): 592-5.
- Hakstian RA. The effects of type of examination anticipated on test preparation and performance. J Educ Res 1971; 64: 319-24.
- Newble DI, Jaeger K. The effect of assessments and examinations on the learning of medical students. Med Educ 1983; 17(3): 165-71.
- Schmidt HG, Norman GR, Boshuizen HP. A cognitive perspective on medical expertise: theory and implication. Acad Med 1990; 65(10): 611-21.
- Bowen JL. Educational strategies to promote clinical diagnostic reasoning. N Engl J Med 2006; 355(21): 2217-25.
- Tamblyn R, Abrahamowicz M, Dauphinee WD, Hanley JA, Norcini J, Girard N, et al. Association between licensure examination scores and practice in primary care. JAMA 2002; 288(23): 3019-26.
- Miller GE. The assessment of clinical skills/competence/performance, Acad Med 1990; 65(9Suppl): S63–7.
- Shumwy JM, Harden RM. AMEE Guide No.25: The assessment of learning outcomes for the competent and reflective physician. Med Teach 2003; 25(6): 569-84.
- Van der Vleuten CP. A paradigm shift in education: how to proceed with assessment, oral presentation given at the 9th International Ottawa Conference on Medical Education, Cape Town, South Africa, 28 February–3 March 2000. Available from: URL: http://www.educ.unimaas.nl/ottawa.
- Van der Vleuten CP, Swanson D. Assessment of clinical skills with standardized patients: state of the art. Teach Learn Med 1990; 2:58-76.
- Ytterberg SR, Harris IB, Allen SS, Anderson DC, Kofron PM, Kvasnicka JH, et al. Clinical confidence and skills of medical students: Use of an OSCE to enhance confidence in clinical skills. Acad Med 1998; 73(10suppl): S103-5.
- Stillman P, Haley H, Regan MB, Philbin MM. Positive effects of a clinical performance assessment program. Acad Med1991; 66(8): 481-83.
- Adamo G. Simulated and standardized patients in OSCEs: achievements and challenges 1992- 2003. Med Teach 2003; 25(3): 262-70.
- Gorter S, Rethans JJ, Sherpbier A, Van Der Heijde D, Houben H, Van der Vleuten CPM, et al. Developing case specific checklists for standardized patient- based assessments in internal medicine: a review of the literature. Acad Med 2000; 75(11): 1130-7.
- Gorter S, Rethans JJ, Van der Heijde D, Sherpbier A, Houben H, Van der Vleuten CP, et al. Reproducibility of clinical performance assessment in practice using incognito standardized patients. Med Educ 2002; 36(9): 827-32.
- Epstein RM. Assessment in medical Education. N Engl J Med 2007; 356: 387-96.
- Chambers DW, Glassman P. A primer on competency-based evaluation. J Dent Educ 1997; 61(8): 651-66.
- Petrusa E. Taking standardized patient-based examinations to the next level. Teach Learn Med 2004; 16(1): 98-110.
- Brown S, Race P, Smith B. 500 Tips on Assessment. London: Routledge; 1996: 9-12.
- Fowell SL, Maudsley G, Maguire P, Leinster SJ, Bligh J. Report of findings: student assessment in undergraduate medical education in the United Kingdom 1998. Medl Educ 2000; 34(1Suppl): 1–78.
- Harden RM. Developments in outcome-based education. Med Teach 2002; 24(2): 117–20.
- Eva KW, Reiter HI, Rosenfeld J, Norman GR. The ability of the multiple mini-interview to predict preclerkship performance in medical school. Acad Med 2004; 79 (10Suppl): S40-2.
- Lypson ML, Frohna JG, Gruppen LD, Woolliscroft JO. Assessing residents’ competencies at baseline: identifying the gaps. Acad Med 2004; 79(6): 564-70.
- Cushing A. Developments in attitude and professional behavior assessment, oral presentation given at the 9th international Ottawa conference on medical education, cape town, south Africa, 28 february–3 march 2000, Available from: URL:http://www.educ. unimaas.nl/ottawa.
- McGuire CH. Reflections of a maverick measurement maven. JAMA1995; 274(9):735-40.
- Batmangelich S, Adamowski S. Maintenance of certification in the United States: a progress report. J Contin Educ Health Prof 2004; 24(3): 134-8.