Assessing professional behaviour and medical error

The mission of medical schools underwent significant change in the post-Second World War period, which resulted in a de-evaluation of teaching, which in turn impacted on the type of assessment methods that emerged in the latter part of the twentieth century. Assessment based on direct observation did not receive the same degree of attention as methods such as multiple choice question and the objective structured clinical examination. During the past two decades medical educators have begun to emphasize the importance of teaching and assessing professional behaviour. It is suggested in this paper that assessment of professional behaviour can best be achieved by means of direct observation. A review of the area of assessment of clinical competence over the past 50 years reveals that it has been dominated by assessment methods that for the most part have been removed from the clinical setting in which medical students work and learn. In this paper it is proposed that there is a need to focus attention on methods of assessment which are based on the direct observation of performance that can be used in the clinical setting. Specifically, more attention needs to be directed at two areas of performance: (1) professionalism, and (2) medical error, both of which have given rise to increasing concern in the medical profession, healthcare agencies and the public at large.