C. Ringsted

A feasibility study comparing checklists and global rating forms to assess resident performance in clinical skills

This study evaluated the feasibility of two different scoring forms for assessing the clinical performance of residents in anaesthesiology. One of the forms had a checklist format including task-specific items and the other was a global rating form with general dimensions of competence including ‘clinical skills’, ‘communication skills’ and ‘knowledge’. Thirty-two clinicians representing 25 (83%) of the 30 training hospitals in the country participated in the study. The clinicians were randomized into two groups, each of which used one of the scoring formats to assess a resident’s performance in four simulated clinical scenarios on videotape. Clinicians’ opinions about the appropriateness of the scoring forms were rated on a scale of 1–5. The checklist format was rated significantly higher compared with the global rating form (mean 4.6, sd 0.5 vs. mean 3.5, sd 1.4, p < 0.001). The inter-rater agreement regarding pass/fail decisions was poor irrespective of the scoring form used. This was explained by clinicians’ leniency as assessors rather than by lack of vigilance in the observations or disagreements on standards for good performance.

Implementation of a formal in‐training assessment programme in anaesthesiology and preliminary results of acceptability

Background:  A new reform on postgraduate education in Denmark requires a formal in‐training assessment in all specialties. The aim of this study was to survey the implementation and acceptability of the first example of a nation‐wide in‐training assessment programme for first‐year trainees in anaesthesiology developed by a working group under the Danish Society of Anaesthesiology and Intensive Care Medicine.

Embracing the new paradigm of assessment in residency training: an assessment programme for first-year residency training in anaesthesiology

Assessment of clinical competence is facing a paradigm shift in more than one sense.The shift relates to test content, which increasingly covers a broader spectrum of competences than mere medical expertise, and to test methods, with an increasing focus on testing performance in realistic settings. Also there is a shift in the concept of assessment in that instruction and assessment are no longer seen as being separate in time and purpose, but as integral parts of the learning process. The nature of the new paradigm for assessment is well described but the challenge to programme directors is to specify the evaluation situations and develop appropriate methods.This paper describes the intrinsic rational validation process in outlining an assessment programme for first-year anaesthesiology residency training according to the new paradigm. The applicability to other residency programmes and higher-level training in anaesthesiology is discussed.

Person-task-context: a model for designing curriculum and in-training assessment in postgraduate education

Structured curricula for senior house officers have often been lacking. The aim of this study was to trial a person–task–context model in designing a curriculum and in-training assessment (ITA) programme for SHOs in internal medicine. A working group designed the programme based on triangulation of information from interviews with trainees and programme directors, analysis of patient case mix and national quality assurance data. The interview data showed that the main difference currently between trainee levels was in expected degree of responsibility for patient management rather than in actual tasks. Key learning needs were how to take a structured approach to the tasks and get an overview of situations. SHOs expressed a need for explicit learning goals and standards of performance. SHOs requested formal teaching in non-medical aspects of competence such as communication, interpersonal skills and professionalism. This article points out how consideration of the type of trainees involved, the tasks they must do and learn, and the context in which they work are important in designing postgraduate curricula. The person–task–context model can be used to tailor curricula and ITA that support learning and may be especially beneficial in promoting learning in non-dominant areas of a specialty.