Vous êtes sur la page 1sur 3


The metric of medical education

Why a series on measurement? forged ahead with developments in than simply hiding, or worse still, com-
Over the last decade significant ad- assessment techniques while others pounding it. Another factor is the place
vances have been made in the assess- still lag far behind. Inconsistency or of assessment in the educational frame-
ment of clinical competence of incoherence is common. Recently, even work often seen as a bolt-on after-
healthcare professionals.13 Historical- the British Medical Journal has shown thought rather than an intrinsic part of
ly, one major stimulus to these bipolar tendencies, with two editorials the curriculum.
advances was the publication, over on the long case, giving contrasting Some of these problems are insoluble
20 years ago, of a paper by Harden perspectives, with neither quoting or or very context-specific; selecting 5%
and Gleeson4 describing how the long acknowledging the other.10,11 There is of house officers for advanced training
case was an inefficient method of clearly a problem. in neurosurgery is a different assessment
assessment and could usefully be problem, requiring different strategies
What now?
supplemented by the objective struc- and solutions, from revalidating an
There are reasons for this dissonance.
tured clinical examination (OSCE). entire profession. However all deserve
One is philosophical. There is a sizeable
Subsequently, simulated patients were to be tackled at least by informed
cohort of medical educators who have
shown to be a feasible method of decision making, if not by precise
been nurtured in paradigms at odds
controlling many testing situations.5 algorithms. After all, assessment is
with the technical rational or statistical
Expertise was developing in both the probably the area of medical educa-
ones that drive much of psychological
USA and in Europe on using new tion that has the most robust evidence
measurement.1214 Adult learning prin-
numerical techniques, such as general- base.
ciples say a lot about negotiated goals
izability theory and Rasch scaling, to
and objectives, but very little about What are we going to do?
improve the precision of measurement
absolute professional standards.15 In an Starting in this issue, the Metric of
of human capacities.6 The First
analogous sense, medicines apparent medical education series will attempt to
Cambridge Conference, in 1984,
general reluctance to deal with enable educators to better understand
catalysed the synthesis of traditional
evidence-based medicine seems to be the basic concepts of assessment, and
(judgement oriented) and psycho-
as much due to the professions unease thus to offer an enhanced rationale for
metric testing procedures, one porten-
with statistical reasoning as it is to attempting measurement of clinical
tous example being the embryonic idea
difficulties in dealing with the competence. In addition, because of
behind key features testing.7 In sum,
application of clinical guidelines to the the close relationship between assess-
these events opened the way to a
patient in the chair, and the apparent ment and the development of appro-
renewed interest in the psychometrics
disenfranchisement this represents.16 priate outcome measures for
of clinical competence.
Clinicians attempting to understand intervention studies, the series will also
This work was enthusiastically
the process of clinical decision making include a how to guide on designing an
developed in the USA, the Netherlands,
have stressed observation, experience, educational experiment. In this latter
Canada and Australia. However, a
inference and judgement,17 and have role, the Metric series will link with
recent survey8 and observations made
only recently been concerned with another forthcoming series on research
by the General Medical Council during
data. Another reason may simply be methods. Metric will comprise short,
its round of visits to medical schools in
ignorance on the part of those charged commissioned articles for the medical
the late 1990s9 highlighted continuing
with devising and administering teacher, researcher and curriculum
deficiencies in the technical aspects of
examinations. designer, written by clinicians and
examinations in the UK. Conversations
Examples of the difficulty examina- assessment specialists working together.
with colleagues worldwide suggest that,
tion boards have in reconciling conflict- The emphasis is on presenting the basic
although there are centres of excellence
ing paradigms can be seen in the framework of assessment and specific
and much good practice, the situation
reluctance to give up negative marking psychometric or assessment techniques.
in many countries is not unlike that in
or correction for guessing of MCQ The first 3 articles will cover theory of
the UK; some medical schools, boards
questions, and in bizarre and opaque assessment, generalizability theory and
and postgraduate institutions have
procedures such as close marking. The study design. Thereafter the planned
latter arose from the difficulty of com- sequence is to cover techniques appro-
bining scores from different tests with priate to the measurement of compe-
Correspondence: Brian Jolly, Centre of widely variant origins or standard devi- tence, followed by those recently
Medical and Health Sciences Education, ations, and from the misguided belief developed or enhanced for looking at
PO Box 15, Monash University, Victoria that attempting to make fewer fine performance. This will be followed by
3800, Australia.
E-mail: brian.jolly@med.monash.edu.au distinctions resolved the issue rather articles on standards.

798  Blackwell Science Ltd ME D I C AL ED U C AT I ON 2002;36:798799

Editorial B Jolly 799

Reader feedback and reliability of methods to assess the 9 General Medical Council. http://
We are asking for reader feedback on competence to practise of pre-regis- www.gmc-uk.org/med_ed/meded_f
the Medical Education website (http:// tration nursing and midwifery stu- rameset.htm (accessed 13/05/02).
www.mededuc.com) during and after dents. Int J Nursing Studies 10 Norcini JJ. The death of the long case?
the Metric series: we would like 2002;39:13345. BMJ 2002;324:4089.
your comments on issues raised, any 3 Wass V, Van der Vleuten C, Shatzer J, 11 Norman G. The long case versus
controversies, and those things you Jones R. Assessment of clinical com- objective structured clinical examina-
always wanted to know but were petence. Lancet 2001;357:9459. tions. BMJ 2002;324:7489.
afraid to ask. If there is a demand 4 Harden R, McG, Gleeson F. Assess- 12 Schon DA. The Reflective practitio-
for topics that we have not previously ment of clinical competence using an ner: how professionals think in action.
covered, then we will try to include objective structured clinical examina- Aldershot, UK: Arena; 1995.
them. In addition, if you think you tion (OSCE). Med Educ 1979;13:41 13 Coles C, Fish D, eds. Developing
have a topic that you could usefully 54. Professional Judgment in Health Care.
contribute to the series please email us 5 Stillman PL, Swanson DB. Ensuring Oxford: Butterworth-Heinemann;
on brian. jolly@med.monash.edu.au the clinical competence of medical 1998.
or j.a.spencer@newcastle.ac.uk. school graduates through standardized 14 Eraut MR. Developing Professional
patients. Arch Intern Med Knowledge and Competence. Lon-
Brian Jolly
1987;147:104952. don: Falmer Press; 1994.
Monash University, Australia
6 Wood R. Assessment and Testing. 15 Beckett D, Hager P. Life, Work and
John Spencer
Cambridge: University of Cambridge Learning: Practice in Postmodernity.
Newcastle, UK
Local Examinations Syndicate; 1991. London: Routledge; 2002.
7 Wakeford, RE, ed. Directions in Clin- 16 Wilson T, Holt T, Greenhalgh T.
icalAssessmentCambridge:Cambridge Complexity science: complexity and
1 Newble DI, Jolly BC, Wakeford RE.
University Medical School; 1985. clinical care. BMJ 2001;323:6858.
The Certification and Recertification
8 Fowell S, Bligh J. Assessment of 17 Elstein AS, Schwarz A. Evidence base
of Doctors: Issues in the Assessment
undergraduate medical education in of clinical diagnosis: Clinical problem
of Clinical Competence. Cambridge:
the UK. Time to ditch motherhood solving and diagnostic decision mak-
Cambridge University Press; 1994.
and apple pie. Med Educ 2001; ing: selective review of the cognitive
2 Norman IJ, Watson R, Murrells T,
35:10067. literature. BMJ 2002;324:72932.
Calman L, Redfern S. The validity

 Blackwell Science Ltd ME D I C A L ED U C A T I ON 2002;36:798799