Assessing the performance of specialist registrars

Abstract

-Assessing the performance of doctors while they are engaged in clinical work is a challenging concept. The introduction of objective-based curricula provides the stimulus and opportunity for the Royal Colleges of Physicians to develop relevant and reliable methods of in-service assessment. We propose to pilot a study investigating the validity, reliability and feasibility of three assessment methodsdirect observation of the clinical encounter using an adapted mini-CEX, direct observation of the performance of practical procedures (DOPS), and the doctor's ability to perform effectively as part of a team using 360°assessment. The methods will be studied in the setting of routine clinical care. Whilst demanding of time from both trainees and trainers, they will represent a significant advance on the current system which is characterised by a lack of evidence in the assessment process.KEY WORDS: assessment, competence, curriculum, performance, specialist registrar, standards IntroductionAssessment of the performance of doctors has recently become an important issue both publicly, as a result of high profile cases such as the Bristol Heart case, and within the profession, following the redesign of higher specialist training. The assessment of doctors in an honest and objective manner is laid out as a fundamental part of practice in the General Medical Council's guidance, Good Medical Practice. 1 At present, the assessment of specialist registrars (SpRs) in medicine is a subjective process. It is based on an educational supervisor 'signing up' a trainee as competent in a specific task in the Record of Training Book. This usually occurs after an arbitrary period of time has been spent by the SpR working in that area and often having completed an arbitrary number of procedures in the case of practical skills. There is no process by which the educational supervisor collects objective evidence to inform judgements about a trainee's competence. It has been acknowledged that there needs to be a greater emphasis on performance-based assessment. There are still no robust mechanisms for formal assessment, and poor performance is not reliably recognised or addressed. There is a real need to develop and implement reliable objective methods of assessment to form an integral part of training of SpRs. The role of the new curriculaThe Joint Committee of Higher Medical Training (JCHMT), which represents all three medical Royal Colleges in the UK, has for some time recognised that there needs to be a review of the approach to specialist physician training. As a result, the JCHMT and specialist advisory committees (SACs) of the medical specialities have rewritten the specialty curricula in line with current educational thinking. The new curricula, which were launched in December 2002, are now objective-based and encompass modern educational principles.Although the content of the new curricula has not changed dramatically, the emphasis of it has. The curricula lay out clear objectives that trainees will have to achieve during ...

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