Author reply

Abstract

Author reply The response of Jauhari et al. to the article by Torda extends the discussion around changes in medical education, as it should, to include assessment. Many of the traditional approaches to the assessment of senior students, which generally include clinical examination, became unfeasible during 2020. There was a variety of responses around the world. Some universities graduated students without clinical examinations, others adapted in a variety of ways, often using a combination of workplace assessments and online examinations. Of note, this problem was not unique to medical students, but has affected examination of medical competency at all levels of vocational training. Many of the Australian specialist colleges have either adapted or postponed barrier examinations of trainees in 2020. At UNSW Sydney, we developed an innovative online Objective Structured Clinical Exam format that enabled assessment of all disciplines and aspects of competency, other than clinical examination (this was assessed in the clinical workplace as described below). Jauhari describes a move to Clinical Workplace Examinations (CWE) to assess clinical competency in the workplace. These have been extensively used and evaluated in medical education see Hurst et al. Although in their example they describe a single in-depth activity, more commonly this approach has been used with the format of multi-source feedback, garnering assessment (and often feedback) on particular aspects or ‘chunks’ of clinical competency, known as the Mini-Clinical Evaluation Exercise. This is used very commonly for formative, as well as for summative, assessment. At UNSW Medicine, we already use CWE in this manner and have developed an application that allows the feedback to be recorded on the student’s mobile and then sent centrally. It is also important to be cognisant of the fact that the development of clinical competencies is a continuum, with different expectations at different levels of medical training. Of note, in 2020, the Australian Medical Council produced a guidance statement for expected clinical practice core competencies, which is standardised for medical graduates across Australia and New Zealand. This letter also further highlights other ‘silver linings’ that have emerged from the need to adapt medical education in the context of the COVID-19 pandemic. These include: