In-training assessment developments in postgraduate education in Europe

This paper reviews changes that are underway in postgraduate medical education in various European countries. Training in the workplace is a very effective way of learning, but it has many imperfections. Changes in in-training assessment are proposed to remedy some of these.

The focus is on a set of assessment tools for performance in authentic work-based contexts. These tools include direct performance measures of single clinical events (mini-Clinical Evaluation Exercise, Direct Observation of Practical Skills, Objective Structured Assessment of Technical Skills, Case-based Discussion, Mini-Peer Assessment Tool) and performance measures over a period of time (Multi-Source Feedback), based on judgement by one or more knowledgeable assessors (supervisor, other healthcare professional, patient, trainee himself/herself). Quantitative and qualitative information from single assessments is first and foremost used to promote learning, but also aggregated across a large sample of contexts and assessors in order to obtain an overall picture of a trainee's progress. Aggregating instruments, such as the portfolio, can be used to collect, support and assess outcomes in terms of competencies achieved. We will describe this set of instruments and provide theoretical background as well as our own practical experiences.

A central message is that the utility of assessment methods lies very much in the (understanding of) the users. Therefore, our concern is more with the actual implementation of change than with the assessment technology per se. If we fail in our efforts to implement real change, postgraduate education may be at risk for bureaucratization and trivialization. We nevertheless are excited to see change happening in the right direction, but remain patient, not expecting very quick wins.