Assessment of Clinical Competency

Domains of clinical competence

Competence builds on a foundation of basic clinical skills, scientific knowledge, and moral development. It has several different domains;


 * Cognitive function: acquiring and using knowledge to solve problems.


 * Integrative function: using biomedical and psychosocial data in clinical reasoning.
 * Relational function: communicating effectively to patients, carers, and colleagues.
 * Affective and moral function: willingness, patience, emotional awareness to use these skills judiciously and humanely.

The central features of assessing clinical competence are to:


 * Establish the range of knowledge, skill, and understanding that an individual should have achieved at a certain stage of their career.


 * Design tasks that appropriately and accurately sample and estimate level of competence.
 * Establish cut off points to separate the competent from the not yet or barely competent.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(00)04221-5/fulltext

Assessment of clinical competence

Millers pyramid Miller’s pyramid (1990) shows a of ranking clinical competence for both educational settings and in the workplace.

It distinguishes between knowledge at the lower levels and action in the higher levels.

In order to truly understand where students or employees stand with certain subjects/tasks, they should be assessed in the setting that we expect them to be delivered.

https://www.stemlynsblog.org/better-learning/educational-theories-you-must-know-st-emlyns/educational-theories-you-must-know-millers-pyramid-st-emlyns/

Level 1 and 2


 * “Assessment of knowledge”


 * This is generally performed using by traditional assessment tools such as written and oral tests.
 * In medical, surgical, and the majority of secondary care specialties this is assessed by the written examinations of the Royal Colleges involving:


 * multiple choice questions (MCQs),
 * best of five questions,
 * extended matching,


 * short answer questions.

Level 3


 * For medical specialties, this level is currently assessed by practical clinical examinations including:


 * objective structured clinical examinations (OSCEs)
 * mini-clinical evaluation exercise (mini-CEX)


 * and/or performance evaluation guides.


 * This type of assessment can be used in a formative or a summative fashion provided the content of the tasks are tailored to the purpose of the examination.

https://pmj.bmj.com/content/80/940/63