Assessment of non-scholastic skills (non-clinical) in trainee residents

Doctors are clinicians and are trained in clinical work. Many non-clinical qualities, apart from the ability to examine and treat, matter a lot in their professional success. Traditionally, knowing the book well or mastering the content of the curriculum was considered enough to succeed in a medical career, but recent recognition of having good communication skills in a physician has changed the medical curricula the world over. A recent look at the formative assessments done to see the on-job trainees during their residencies in various countries, like India, the United States and Turkey, has revealed that most trainees are overworked and find it difficult to cope with the demanding training requirements centred around mastering the clinical skills. The supervisors are also very busy. Non-scholastic abilities, like good emotional quotient and extracurricular activities that do not directly relate to things learnt from the book or the ward are being graded as very important for medical students because all these abilities are essential for a doctor not only to help the patients medically and psychologically, but also emotionally. He should be able to protect his self from care-provider's stresses. Personal qualities of a doctor are seen as important predictors of clinical performance in medicine. There are opportunities during training that the senior trainer can become a role model and impart non-scholastic skills most effectively. Supervisors must show their trainees how to behave with a patient. This change in attitude and behaviour has to be induced by performing these things in front of the trainee residents. The problem with non-scholastic skills, unlike the scholastic cognitive/psychomotor domains, is that these skills are quite elusive to routine assessments. However, lone reliance upon a final examination for assessing attitudes can be biased. If the behaviour of residents is to be tested in an exit examination they are likely to behave more consciously only to pass the examination, which is called the Hawthorne effect. No one can ensure that one behaves in a uniform manner in every social situation. Our responses may vary every day in the face of emerging challenges. Probably a balanced combination of formative plus summative assessment supplemented with a well-planned continuous internal assessment is the answer.