Structured Assessments of Clinical Competence
Clinical teachers are often involved in assessments of clinical competence in the workplace, in universities and Colleges. Assessments commonly used to formally assess clinical competence include long and short cases and the objective structured clinical examination which, if well designed, is a fair and reliable method of assessing clinical competence.
This module outlines the theoretical principles underlying the development of modern structured assessments of clinical competence and describes some practical aspects of designing and implementing objective structured clinical examinations (OSCEs).
The reliable and valid assessment of clinical competence has become an increasingly important area of concern in medical education as the psychometric properties of different assessment tools have been researched and better understood.
While Miller’s model of professional competence (Miller, 1990) illustrates that competence is underpinned by a thorough base of specialist medical knowledge, the term clinical competence encompasses other professional practice elements such as history taking and clinical examination skills, skills in practical procedures, doctor-patient communication, problem solving ability and management skills, relationships with colleagues and ethical behaviour.
As written tests do not assess clinical skills, the assessment of clinical competence has historically involved the direct observation of candidates by professional colleagues. A variety of formats for assessing clinical competence has developed over the years including the ‘classic’ long and short case formats and newer methods such as the OSCE.
Before you start
Before you start the module, we recommend that you spend a few minutes thinking about the following points and noting down some of your thoughts. If you are registered on the site, you can do this in the ‘reflections area’. Click on the ‘my area’ link at the top of the page to access your personal pages. Please note that you must be logged in to do this. Please also note that you will need to contribute to the ‘reflections area’ during the course of the module in order to complete and print out your certificate.
How would you describe your own experience of clinical assessment:
(a) As a learner?
(b) As a teacher?
What formal structures were/are used in these assessments?
How do you think these types of assessments work in assessing clinical competence and performance?
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