Preparing for assessment

General principles

Clinical assessments are integral to undergraduate and postgraduate medical education and training, and are designed to verify that those involved in the care of patients meet safe clinical standards. Assessments can be formative and/or summative. Formative assessments (such as workplace-based assessments and progress tests) allow you to receive feedback on and monitor your own performance. Assessments such as these can be highly effective adjuncts to learning if they promote reflection on your own performance and recognition of areas for improvement and further development. Summative assessments, on the other hand, are used to evaluate whether you have achieved a required competence or standard of proficiency in terms of knowledge, skills or performance, which may be set by licensing bodies such as the General Medical Council in the UK or postgraduate colleges. Assessments can also be used to provide evidence of safe practice: for example, simulation assessments for doctors in difficulty, or for recruitment and selection into specialty training.

This chapter provides an overview of the spectrum of clinical assessment methods, with a particular emphasis on objective structured clinical examinations (OSCEs) and clinical simulation scenarios. Guidance is offered on how to prepare for formal assessment, including the role of deliberate rehearsal, along with suggestions for optimising your performance in clinical and communication skills assessment.

Methods of assessment

The most widely used clinical assessment methods include OSCEs, short cases, long cases and clinical simulation scenarios ( Box 22.1 ), during which you may be observed performing an integrated sequence of clinical, practical and/or communication skills.

Different assessment formats test different aspects of your professional competence or expertise. Short cases, for example, will usually focus on testing either your clinical examination skills or your ability to take a history from a patient. Modern assessment methods, such as OSCEs and clinical simulation, allow assessment of knowledge, skills and professional behaviours in an integrated manner and can permit candidates to demonstrate a higher level of performance through ‘showing how’ and ‘doing’ ( Fig 22.1 ). Increasingly, assessment of communication skills is being undertaken remotely. In this situation, the focus of the assessment is likely to be on taking a history, or giving explanation and/or advice to a patient or surrogate in a community setting. Make sure that your remote environment is suitable for the assessment, with adequate technology and lighting, and be aware that you may lose some of the non-verbal cues that you might ordinarily rely on during an in-person consultation (see p. 4 for guidance on remote consultations).

Assessments are linked to the learning outcomes of a course or curriculum, and ‘blueprinting’ is used to ensure that there is appropriate coverage of the required knowledge, skills and behaviours across the examination. To perform well in clinical assessments, it is therefore crucial that you familiarise yourself with both the curriculum and the domains or skills on which you are being assessed. Not all skills will be assessed at each examination ( Box 22.2 ).

Once you have achieved a standard of competence in a clinical skill or domain, you may be considered ‘entrustable’ in this professional activity. For example, a final-year medical student may be ‘entrusted’ to perform peripheral cannulation on a patient if they have demonstrated competence in the specified domains (such as obtaining consent from a patient for the procedure and technical competence in the procedure itself).

Clinical simulation

Clinical simulation, using either high-fidelity patient mannequins or simulated patients, is increasingly employed for teaching and learning in healthcare, as it supports deliberate rehearsal of clinical skills in a realistic setting without compromising patient safety. Experiential learning such as this (‘learning by doing’) also supports the transition from theory to practice. Clinical simulation is commonly included in both undergraduate and postgraduate assessments to evaluate a candidate’s ability to integrate a number of complex skills or domains, which may include clinical examination, practical skills and drug or fluid prescribing. Often the scenario will involve an acutely unwell patient who is experiencing a medical emergency such as life-threatening asthma, where the use of a real patient is not feasible ( Box 22.3 ). The patient mannequin is set up in a realistic clinical environment (such as a simulated ward), with real props and equipment (such as a nebuliser mask), and there is often an additional member of staff in the room (playing the role of the nurse, for example) who can perform tasks and provide results of investigations if requested by the candidate. Sometimes a facilitator may also be the ‘voice’ of the patient, giving important prompts (‘I can’t breathe’ or simulating an audible wheeze). The candidate instructions will clarify what is expected of you, but it is likely that you will be assessed on your competence in physical assessment, communication skills and the initial management of the patient.

22.3

Clinical simulation station

Life-threatening asthma.

You are a junior doctor on the admissions unit. The nurses ask you to see a 25-year-old male patient (the mannequin) with breathlessness whom they are concerned about. There is also a nurse present who can help you with appropriate tasks.

Typical domain-based mark sheet: life-threatening asthma simulation station

	Fail	Borderline	Good	Excellent
Structured initial assessment			✓
Recognition of severity of illness			✓
Initial management and resuscitation	✓
Interpretation of results		✓
Safe and appropriate prescribing		✓
Escalation of care		✓
Formulation of an ongoing management plan		✓

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