Clinical education encompasses numerous elements. As a result, assessment of student practices in clinical settings must be complex and multidimensional. The goal of this paper is to review the current state of research into clinical assessments and provide recommendations to improve the quality of assessment procedures in clinical settings. The paper includes a brief evaluation of the supervisor and student’s role in clinical assessment.
Clinical Practices Paper
Assessment of students in clinical settings is one of the most challenging tasks encountered by medical professionals and supervisors. Most practicing physicians are currently involved in assessing the extent to which their trainees are successful in achieving the clinical and learning objectives (Epstein, 2007). However, not all practicing physicians can define the most appropriate criteria of competent performance; many of them fail to develop appropriate assessment instruments. The current state of literature offers a broad choice of clinical assessment instruments, but the evidence supporting their validity is rather scarce. This being said, clinical professionals and supervisors must use more than one instrument of assessment and make sure that students have voice in assessment procedures and decisions.
Clinical Assessment: Review of Literature
The range and diversity of clinical assessment methods cannot be overstated. Most physicians are involved in assessing the competencies and skills of their trainees; in the meantime, researchers try to improve the existing and develop new models of clinical assessment. The current state of literature provides a wealth of information about clinical assessment methods. Epstein (2007) performed a broad meta-examination of the assessment methods available to clinicians. As always, written examinations and assessments by supervising clinicians remain the most frequent elements of assessment in clinical settings (Epstein, 2007). “Supervising clinicians’ observations and impressions of students over a specific period remain the most common tool used to evaluate performance with patients” (Epstein, 2007, p.389). Comments provided by supervisors exemplify a unique and extremely useful source of practical recommendations for students. To observe trainees frequently and continuously clinical supervisors can use mini-clinical-evaluation exercises, through direct observation or by means of video review (Epstein, 2007). In these exercises clinical supervisors usually observe the way students deal with patients, examine them and take their history over the period of 10-20 minutes (Epstein, 2007). Clinical simulations are a common instrument of student assessment in clinical settings (Epstein, 2007). Multisource assessments and student portfolios are becoming widespread (Epstein, 2007).
Later, Epstein, Siegel and Silberman (2008) explored the role and place of self-monitoring in clinical assessment and concluded that self-monitoring could be used to help clinicians assess student knowledge and competencies. Kogan, Holmboe and Hauer (2009) added to the body of literature concerning clinical assessment and found that, although clinicians had a wide choice of assessment instruments, evidence supporting their validity and positive outcomes was at least scarce. Unfortunately, all studies reviewed in this paper rely on secondary findings; as a result, their conclusions and outcomes need further analysis and validation. Clinical environments undergo constant changes, and clinicians need new models of assessment, to promote objectivity and progress in clinical supervision and education. Nevertheless, it is still possible to develop recommendations and improve the efficiency of assessment frameworks used in clinical environments.
To improve the quality of assessment procedures, clinical supervisors should 1) use more than one method of assessment; and 2) test the validity of various assessment techniques in clinical settings. The use of more than one assessment method is justified by the fact that competences are contextual, and the methods used to assess student competencies vary, depending on the context. In one situation video reviews and written examinations may become the best way to assess student achievements, whereas in other clinical settings supervisors may need to combine student portfolios with peer feedbacks (Epstein, 2007). Whatever method clinical supervisors decide to choose, they must ensure its validity against the contextual environment where it is used. This is possible by reviewing the most recent research findings and adjusting standardized methods of assessment to meet the specific contextual requirements. Since most clinical assessment methods lack sufficient empirical support, it is imperative that clinicians initiate a broad analysis of the existing and new assessment models, to facilitate the integration of theory and practice. The main theoretical underpinnings of each clinical assessment model have to be reviewed. Simultaneously, clinical supervisors should not overestimate their place in clinical assessments and forget about the importance of self-assessment and peer feedbacks.
Self-monitoring and self-assessment are essential prerequisites of quality assessment in clinical settings. Clinical supervisors must ensure that students have voice in all assessment procedures. Standardized assessments alone cannot suffice, as students must express their perceptions and concerns with regard to the clinical practices in which they participate (Epstein et al., 2008). The risks inherent in self-assessment procedures should not be disregarded: students and supervisors must be able to distinguish between high-quality objective data, as well as projection and imagination (Epstein et al., 2008). Self-assessment is important in that it provides contextualized feedback and facilitates self-monitoring in clinical settings (Epstein et al., 2008). Here, self-assessment procedures can be further supplemented by collaborative activities that require peer feedback.
The Role of Students and Supervisors in Clinical Assessment
Students and supervising clinicians must participate in all assessment procedures in equal terms. Simultaneously, clinical supervisors are to bear the main burden of decision-making and responsibility for the quality of assessment procedures used. Clinical supervisors are to remain the central instruments of clinical assessment, although the choice of assessment formats should be made with caution. Clinical assessment may have a lot of unintended consequences and distract students’ attention from important clinical issues (Epstein, 2007), but clinical supervisors possess experience and skills to implement relevant assessment frameworks. In this sense, the role of the clinical supervisor is to guarantee that (a) there is a reasonable balance of various assessment methods; and (b) students are not overloaded with examinations. Clinical supervisors must avoid using direct observation as the sole method of assessing student skills; human observation is an extremely subjective process associated with biases and inconsistency (Stuart, 2003). Also clinical supervisors must make sure that the formats of examination do not change during the course, as individuals study more thoroughly when they anticipate certain assessment formats (Epstein, 2007). Clinical assessments should not discourage students but, on the contrary, encourage reflective learning and self-monitoring on an ongoing basis.
The current state of literature provides ample information about various models of assessment in clinical settings. Unfortunately, evidence supporting the validity of these models is rather scarce. While clinical supervisors carry the main burden of decision-making and assessment responsibility, students should have voice in all assessment procedures. Self-monitoring and self-assessment, coupled with peer feedback, should become integral components of clinical assessment procedures. With more than one assessment method used, these recommendations will encourage reflective learning and self-monitoring among medical students on a daily basis.