Broadening Perspectives on Clinical Performance Assessment: Rethinking the Nature of In-training Assessment
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In-training assessment (ITA), defined as multiple assessments of performance in the setting of day-to-day practice, is an invaluable tool in assessment programmes which aim to assess professional competence in a comprehensive and valid way. Research on clinical performance ratings, however, consistently shows weaknesses concerning accuracy, reliability and validity. Attempts to improve the psychometric characteristics of ITA focusing on standardisation and objectivity of measurement thus far result in limited improvement of ITA-practices.
The aim of the paper is to demonstrate that the psychometric framework may limit more meaningful educational approaches to performance assessment, because it does not take into account key issues in the mechanics of the assessment process. Based on insights from other disciplines, we propose an approach to ITA that takes a constructivist, social-psychological perspective and integrates elements of theories of cognition, motivation and decision making. A central assumption in the proposed framework is that performance assessment is a judgment and decision making process, in which rating outcomes are influenced by interactions between individuals and the social context in which assessment occurs.
The issues raised in the article and the proposed assessment framework bring forward a number of implications for current performance assessment practice. It is argued that focusing on the context of performance assessment may be more effective in improving ITA practices than focusing strictly on raters and rating instruments. Furthermore, the constructivist approach towards assessment has important implications for assessment procedures as well as the evaluation of assessment quality. Finally, it is argued that further research into performance assessment should contribute towards a better understanding of the factors that influence rating outcomes, such as rater motivation, assessment procedures and other contextual variables.
Keywordsclinical competence clinical education clinical ratings competence assessment educational measurement in-training assessment performance assessment rating process
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The authors would like to thank Mereke Gorsira for critically reading and correcting the English manuscript.
- Bernardin, H.J., Orban, J.A. & Carlyle J.J. (1981). Performance ratings as a function of trust in appraisal and rater individual differences. Academy of Management Proceedings: 311–315Google Scholar
- Cardy R.L., Bernardin H.J., Abbott J.G., Senderak M.P., Taylor K. (1987) The effects of individual performance schemata and dimension familiarization on rating accuracy. Journal of Occupational Psychology 60: 197–205Google Scholar
- Chi M.T.H., Glaser R., Farr M.J. (1989). The Nature of Expertise. Hillsdale, New JerseyGoogle Scholar
- Clauser B.E., Schuwirth L.W.T. (2002). The use of computers in assessment. In: G.R. Norman, C.P.M. van der Vleuten, D.I. Newble (eds), International Handbook of Research in Medical Education, Kluwer Academic Publishers, Dordrecht, pp.757–792Google Scholar
- DeNisi A.S., Williams K.J. (1988). Cognitive approaches to performance appraisal. In: G. Ferris, K. Rowland (eds) Research in Personnel and Human Resource Management (Vol. 6). JAI Press, Greenwich, CTGoogle Scholar
- Erdogan B., Kraimer M.L., Liden R.C. (2001). Procedural justice as a two-dimensional construct. An examination in the performance appraisal context. Journal of Applied Behavioural Science 37(2): 205–222Google Scholar
- Fiske S.T., Taylor S.E. (1991). Social Cognition (2nd ed). McGraw-Hill, New YorkGoogle Scholar
- Guba E., Lincoln Y. (1989). Fourth Generation Evaluation. Sage Publications, LondonGoogle Scholar
- Hogg M.A. (2003). Introducing social psychology. In: Hogg M.A. (ed) Social Psychology, Vol. I: Social Cognition and Social Perception. Sage Publications, London, pp xxi–lixGoogle Scholar
- Krefting L. (1991). Rigor in qualitative research: the assessment of trustworthiness. American Journal of Occupational Therapy 45: 214–222Google Scholar
- Kozlowski S.W.J., Mongillo M. (1992). The nature of conceptual similarity schemata: examination of some basic assumptions. Personality and Social Psychology Bulletin 18: 88–95Google Scholar
- Longenecker C.O., Gioia D.A. (2000). Confronting the “politics” in performance appraisal. Business Forum, 25(3,4): 17–23Google Scholar
- van Luijk, S.J., van der Vleuten, C.P.M. & Schelven, R.M. (1990). The relation between content and psychometric characteristics in performance-based testing. In W. Bender, R.J. Hiemstra, A.J.J.A. Scherpbier & R.P. Zwierstra (eds.), Teaching and Assessing Clinical Competence, pp. 497–502. Groningen: Boekwerk PublicationsGoogle Scholar
- McDowell L. (1995). The impact of innovative assessment on student learning. Innovations in Education and Training International, 32(4): 302–313Google Scholar
- McGaghie, W.C. (1993). Evaluating competence for professional practice. In: L. Curry, J.F. Wergin & Associates (eds.), Educating Professionals: Responding to New Expectations for Competence And Accountability, pp. 229–261. San Francisco: Jossey-Bass Inc., PublishersGoogle Scholar
- Murphy K.R., Cleveland J.N. (1995). Understanding Performance Appraisal. Social, Organizational and Goal-based Perspectives. Sage Publications, Thousand Oaks, CAGoogle Scholar
- Noel G.L., Herbers J.E.J., Caplow M.P., Cooper G.S., Pangaro L.N., Harvey J. (1992). How well do internal medicine faculty members evaluate the clinical skills of residents? Annals of Internal Medicine 117: 757–765Google Scholar
- Petrusa E.R. (2002). Clinical performance assessments. In: G.R. Norman, C.P.M. van der Vleuten, D.I. Newble (eds), International Handbook of Research in Medical Education, Kluwer Academic Publishers, Dordrecht, pp.673–709Google Scholar
- Reznick R.K., Rajaratanam K. (2000). Performance-based assessment. In: L.H. Distlehorst, G.L. Dunnington, J.R. Folse (eds) Teaching and Learning in Medical and Surgical Education. Lessons Learned for the 21st Century, Lawrence Erlbaum Ass, Mahwah NJ, pp. 237–243Google Scholar
- Rothman A.J., Schwarz N. (1998). Constructing perceptions of vulnerability: personal relevance and the use of experiential information in health judgments. Personality and Social Psychology Bulletin 24(10): 1053–1064Google Scholar
- Sloan D.A., Donnelly M.B., Drake D.B., Schwartz R.W. (1995). Faculty sensitivity in detecting medical students’ clinical competence. Medical Teacher 17(3): 335–342Google Scholar
- Sulsky L.M., Keown J.L. (1999). Performance appraisal in the changing world of work: implications for the meaning and measurement of work performance. Canadian Psychology 39(1–2): 52–59Google Scholar
- Tetlock P.E. (1985). Accountability: the neglected social context of judgment and choice. In: L.L. Cummings, B.M. Staw (eds) Research in Organizational Behavior Vol. 7, JAI Press, Greenwich, CT, pp 297–332Google Scholar
- Turnbull J., Barneveld van C. (2002). Assessment of clinical performance: in-training evaluation. In: G.R. Norman, C.P.M. van der Vleuten, D.I. Newble (eds), International Handbook of Research in Medical Education, Kluwer Academic Publishers, Dordrecht, pp. 793–810Google Scholar
- Verhulst S., Colliver J., Paiva R., Williams R.G. (1986). A factor analysis of performance of first-year residents. Journal of Medical Education 61: 132–134Google Scholar
- Williams K.J., DeNisi A.S., Blencoe A.G., Cafferty T.P. (1985). The role of appraisal purpose: effects of purpose on information acquisition and utilization. Organizational Behavior and Human Performance 35: 314–339Google Scholar
- Woehr D.J., Huffcutt A.I. (1994). Rater training for performance appraisal: a quantitative review. Journal of Occupational and Organisational Psychology 67: 189–205Google Scholar
- Zedeck S. (1986). A process analysis of the assessment center method. Research in Organizational Behavior 8: 259–296Google Scholar
- Zieky M.J. (2001). So much has changed: how the setting of cutscores has evolved since the 1980s. In G.J. Cizek (ed) Setting Performance Standard: Concepts, Methods and Perspectives, Lawrence Erlbaum Associates, Mahwah NJ, pp. 19–53Google Scholar