Guidelines for assessing clinical competence

Medical organizations responsible for assessing the clinical competence of large numbers of examinees have traditionally used written, oral, and observation‐based examination methods. The results from these examinations form the basis for major professional decisions regarding promotion or privileges of medical students or physicians. In this article, we present a set of guidelines that examining bodies should follow in developing and implementing assessment procedures that are a valid reflection of examinees’ current level of competence and of their ability to perform satisfactorily at the next stage of training or practice. The guidelines are based on our collective experiences as well as the growing literature on assessment of clinical competence. The discussion covers issues that have not been fully addressed in previously published reviews, including identifying the competencies to be tested, selecting appropriate and realistic test methods, dealing with test administration and scoring, and setting standards for the desired level of performance.