The assessment of professional competence: Developments, research and practical implications.

Educational achievement testing is an area of turmoil in the health sciences. Examinations are a constant source of problems for many teachers, curriculum designers and educationalists. The evaluation of student achievement is continuously debated at educational meetings, conferences and workshops. It is an area in which tradition, personal values and experiences tend to dominate discussions. On the other hand, the number of scientific publications on assessment over the last decade has exploded. The number of proposed instruments, each preferably using an intriguing acronym, is countless. The literature is however often difficult to access since the psychometrics usually involved in educational testing discourage the average health professions reader. Assessment in the health professions education is nevertheless an area which is fortunately well-researched and has delivered a number of well-documented outcomes. The purpose of this article is to highlight these outcomes and to attempt to translate them into practical implications and research suggestions. We will not review individual methods and instruments in detail, but will describe some classes of methods contingent on a (supposed) theoretical framework. We will delineate what we consider paramount findings within and across these classes and discuss their theoretical implications and their effect on the evolution of new testing instruments. By using a simple conceptual framework the utility of assessment methods will subsequently be defined in a generic sense meant to be helpful in deciding how to compromise and make trade-offs in assessment practice. To improve the utility of assessment a number of practical suggestions and research recommendations are proposed using this framework.