Conceptual and practical challenges in the assessment of physician competencies

Abstract

The shift to using outcomes-based competency frameworks in medical education in many countries around the world requires educators to find ways to assess multiple competencies. Contemporary medical educators recognize that a competent trainee not only needs sound biomedical knowledge and technical skills, they also need to be able to communicate, collaborate and behave in a professional manner. This paper discusses methodological challenges of assessment with a particular focus on the CanMEDS Roles. The paper argues that the psychometric measures that have been the mainstay of assessment practices for the past half-century, while still valuable and necessary, are not sufficient for a competency-oriented assessment environment. New assessment approaches, particularly ones from the social sciences, are required to be able to assess non-Medical Expert (Intrinsic) roles that are situated and context-bound. Realist and ethnographic methods in particular afford ways to address the challenges of this new assessment. The paper considers the theoretical and practical bases for tools that can more effectively assess non-Medical Expert (Intrinsic) roles.

Acknowledgments

We would like to thank Dr. Risa Freeman for her reflections on the development of this paper and Carrie Cartmill for assistance with manuscript preparation.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Notes

1. The term “non-Medical Expert” has become common parlance as a way to describe all the Roles except for “Medical Expert”. The Royal College of Physicians and Surgeons of Canada has recently endorsed the use of the term “Intrinsic Roles” as an alternate.