Assessment of competence and progressive independence in postgraduate clinical training

Abstract

From our study, it is evident that both determining the level of competence of a trainee for a certain professional activity and making decisions about the degree of independence entrusted to a trainee are complex, multi-factorial processes, which are not always transparent. Furthermore, competence achieved in a certain clinical procedure does not automatically translate into more independent practice. We discuss the implications of our findings for the assessment of clinical competence and provide suggestions for a transparent assessment structure with explicit attention to progressive independence.

Essential Facets of Competence That Enable Trust in Graduates: A Delphi Study Among Physician Educators in the Netherlands

“…13,14 These factors include the characteristics and achieved level of competence of the trainees. In the current study we clarified which FOCs of the trainees appear relevant for entrustment decisions.…”

“…12 In clinical settings supervisors decide on a daily basis whether to trust a medical trainee with a specific task and to what extent supervision is needed. [13][14][15][16] Specific tasks pertain to a given procedure or skill that is to be carried out; general features pertain to task-independent characteristics. These general features can be called facets of competence (FOCs).…”

Review article: Closing the research gap at the interface of learning and clinical practice

“…86 Recent efforts to enhance implementation and application of the competencies have focused on the development of educational milestones, namely, accepted defined aspects of clinical competence that should be attainable at a certain stage of training, and teaching and assessment regarding entrustable professional activities (EPAs). [89][90][91] Entrustable professional activities are ''real-life'' clinical tasks (e.g., the preoperative anesthesia assessment of a patient undergoing elective surgery) that incorporate a number of discrete elements of clinical performance and with each element being comprised of several competencies. These clinical tasks can be ''entrusted'' to a resident by faculty with supervision present or remote and with feedback that includes both a holistic focus on the entrusted activity as well as disaggregated suggestions for components such as communication or advocacy.…”

“…84 This attribute of EPAs has the potential to bridge another gap, i.e., the discrepancy between the theory and the practice related to the competencies, and it is viewed by a growing number of educators as the new building block for the assessment of residents' acquisition of competence. 84,[89][90][91] What is largely lacking to date is research to develop and test tools and to establish their relationship to the accepted observable abstractions called the competencies and to the newer concepts of the milestones and EPAs. Also, studies are lacking to validate that teaching and evaluation using the deconstructed concept of the competencies produces better physicians.…”

The Role of Generic Competencies in the Entrustment of Professional Activities: A Nationwide Competency-Based Curriculum Assessed

“…14 In theory, evidence of competence may come from several factors: level of performance observed by a supervisor, scores on workplace-based assessments (WBAs), experience in an activity, and training completed by a resident. 4,12,15 In practice, entrustment decisions likely are influenced by informal assessments, supervisor characteristics, and the demands of the clinical situation. 16 Yet, little research has been done about how entrustment decisions are reached in daily practice 17 and whether generic competencies play a role.…”