Journal of Continuing Education in the Health Professions



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CURRENT ISSUE BACK ISSUES SUBSCRIBE ADVERTISE ABOUT JCEHP FOR AUTHORS JCEHP AWARD SEARCH		Volume 23 (3) Volume 23, Issue 3, Summer 2003 J Contin Educ Health Prof 2003; 23(3):182-190 INNOVATIONS IN CONTINUING EDUCATION Assessment of clinical skills in medical practice Scoles PV Hawkins RE LaDuca A A b s t r a c t The introduction of a clinical skills examination (CSE) to Step 2 of the U.S. Medical Licensing Examination (USMLE) has focused attention on the design and delivery of large-scale standardized tests of clinical skills and raised the question of the appropriateness of evaluation of these competencies across the span of a physician's career. This initiative coincides with growing pressure to periodically assess the continued competence of physicians in practice. The USMLE CSE is designed to certify that candidates have the basic clinical skills required for the safe and effective practice of medicine in the supervised environment of postgraduate training. These include history taking, physical examination, effective communication with patients and other members of the health care team, and clear and accurate documentation of diagnostic impressions and plans for further assessment. The USMLE CSE does not assess procedural skills. As physicians progress through training and enter practice, both knowledge base and requisite technical skills become more diverse. A variety of indirect and direct measures are available for evaluating physicians, but, at present, no single method permits high-stake inferences about clinical skills. Systematic and standardized assessments make a contribution to comprehensive evaluations, but they retain an element of assessing capacity rather than authentic performance in practice. Much work is needed to identify the optimal combination of methods to be employed in support of programs to ensure maintenance of competence of practicing physicians. Lessons for Practice Clinical skills constitute the interface between a physician's knowledge base and technical skills and a patient's problem. Existing standardized assessments of clinical skills assess capacity rather than authentic performance in practice. Assessment methods appropriate for evaluation of physicians for initial licensure may not be sufficient for assessment of the performance of practicing physicians. A variety of indirect and direct measures are available for evaluating physicians, although some form of direct observation of physicians seems essential to support inferences about clinical skills for high-stake decision making. MeSH Terms: Clinical Competence; Education, Medical, Undergraduate; Educational Measurement; Physicians
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