Clerkship assessment assessed

Abstract

This article reviews consistent research findings concerning the assessment of clinical competence during the clerkship phase of the undergraduate medical training programme on issues of reliability, validity, effect on training programme and learning behaviour, acceptability and costs. Subsequently, research findings on the clinical clerkship as a learning environment are discussed demonstrating that the clinical attachment provides a rather unstructured educational framework. Five fundamental questions (why, what, when, how, who) are addressed to generate general suggestions for improving assessment on the basis of the evidence on assessment and clinical training. Good assessment requires a thoughtful compromise between what is achievable and what is ideal. It is argued that educational effects are eminently important in this compromise, particularly in the unstructured clinical setting. Maximizing educational effects can be achieved in combination with improvements of other measurement qualities of the assessment. Two concrete examples are provided to illustrate the recommended assessment strategies.

Medical students’ preparedness for professional activities in early clerkships

“…Overall and in line with other reports, students in this study themselves differed greatly in regard to the number and type of clerkship activities [ 3 , 4 , 34 , 35 ], which is likely a reflection of the differences in clerkship settings. Taking a patient’s history and performing a physical examination constituted the main tasks in our early clerkships.…”

“…During the performance of another third of activities, the supervisor was easily available. These may be seen as positive findings in terms of students’ learning opportunities, feedback and assessment [ 4 , 35 , 45 ], and are in divergence with other reports where direct supervision is more often lacking than available [ 3 , 4 , 35 , 46 ]. In addition, the students reported executing about one third of their activities under distant supervision.…”

“…Analysis of students’ learning during early clerkships has been found to be challenging. It seems to occur within a so-called “black box” and existing findings show a high variation in workplace involvement and supervision [ 3 , 4 , 34 , 35 ]. A novel perspective to capture workplace participation in clerkships is offered by analysing which professional activities students actually carry out and how they are supervised.…”

Workplace-based assessment of communication skills: A pilot project addressing feasibility, acceptance and reliability

“…The aim of a workplace-based assessment is to observe specific student performance during routine clinical work and to provide feedback to guide learning [16], [17], [18]. In medical education, structured observation and feedback in the workplace often concentrate on practical skills such as anamnesis or physical examination techniques.…”

Lernen am späteren Arbeitsplatz: eine Analyse studentischer Erwartungen an den Stationseinsatz im Fachbereich der Inneren Medizin

“…International studies consistently show that the quality of the medical internship varies hugely, because internship rotations are carried out at different hospital sites, with different supervisors and with variations in terms of the mix of patients. Bedside teaching is far less structured and standardized than theoretical learning during the preclinical training, where all students complete the same program, study the same material, read the same books and take the same final examinations [ 38 ], [ 40 ]. International studies also confirm that students on the ward spend too much time on activities that have little educational value [ 5 ], [ 10 ], [ 30 ], [ 37 ], [ 40 ].…”