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September 6, 1995

Assessing Clinical PerformanceWhere Do We Stand and What Might We Expect?

Author Affiliations

From the Medical Council of Canada, Ottawa, Ontario.

JAMA. 1995;274(9):741-743. doi:10.1001/jama.1995.03530090073025

During the past decade the field of clinical assessment has demonstrated a clear move away from dependence on pencil and paper tests and the multiple-choice format as measures of predicting clinical competence to assessing what physicians do in the real world of practice.1 This change is reflected in the orientation of numerous conferences on newer approaches to clinical assessment.2-5

See also p 735.

Among the many reasons for this shift are the increasing feasibility of administering large-scale, multicenter performance tests and the documented improvement in the measurement qualities of performance-based tests. These tests include the Objective Structured Clinical Examination (OSCE), in which candidates proceed through multiple, timed, independent stations designed to assess predetermined clinical skills, and the use of standardized patients (SPs), that is, lay people who are trained to simulate a variety of medical problems in a consistent, reliable, and realistic manner. Another reason for the shift

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