Assessing professional competence: from methods to programmes

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Table 1: Reliability estimates of different assessment instruments as a function of testing time.



Reliability for Different Testing Times

1 hour

2 hours

4 hours

8 hours

Multiple Choice1,4

Short stem and short menu of options





Patient Management


Simulation of patient full scenarios





Key Feature

Case (Write-in)1,5

Short patient case vignette followed by write-in answer







Oral examination based on patient cases





Long Case


Oral examination based on previously unobserved real patient






Simulated realistic encounters in round robin format





Mini-Clinical Exercise (Mini-CEX)3,9

Short follow-up oral examination based on previously observed real patient





Practice Video


Selected patient-doctor encounters from video recordings in actual practice





Incognito Standardised Patients3,11

Real consultations scored by undetected simulated patients





1One-facet all random design with items crossed with persons (pxi)

2Two-facet all random design with judges (examiners) nested within items within persons (j:i:p)

3One-facet all random design with items nested within persons (i:p)

4Norcini JJ, Swanson DB, Grosso LJ, Webster GD. Reliability, validity and efficiency of multiple choice question and patient management problem item formats in assessment of clinical competence. Medical Education 1985;19(3):238-47.

5Hatala R, Norman GR. Adapting the key features examination for a clinical clerkship. Medical Education 2002;36(160-165).

6Swanson DB. A measurement framework for performance-based tests. In: Hart I, Harden R, editors. Further developments in Assessing Clinical Competence. Montreal: Can-Heal publications, 1987:13 - 45.

7Wass V, Jones R, Van der Vleuten C. Standardized or real patients to test clinical competence? The long case revisited. Medical Education 2001;35:321-325.

8Vleuten, C.P.M. van der, Luijk, S.J. van & Swanson, D.B. (1988) Reliability (generalizability) of the Maastricht skills test. Proceedings of the Twenty-seventh Annual Conference on Research in Medical Education (RIME). Chicago: American Association for Medical Colleges, USA.

9Norcini JJ, Blank LL, Duffy FD, Fortna GS. The mini-CEX: a method for assessing clinical skills. Annals of Internal Medicine 2003;138(6):476-481.

10Ram P, Grol R, Rethans JJ, Schouten B, Van der Vleuten CPM, Kester A. Assessment of general practitioners by video observation of communicative and medical performance in daily practice: issues of validity, reliability and feasibility. Medical Education 1999;33(6):447-454.

11Gorter S, Rethans JJ, Van der Heijde D, Scherpbier A, Houben H, Van der Vleuten C, et al. Reproducibility of clinical performance assessment in practice using incognito standardized patients. Medical Education 2002;36(9):827-832

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