Assessment of clinical competence. The state of the art

Clinical competence (CC) can be defined as the professional skills required to act and represents the fundamental background required for the performance. From a taxonomic standpoint, CC regards the field of knowledges, gestures, behaviours and decision-making skills in patient management on the basis of a cost-benefit analysis. "Methods for the assessment of CC". Since the 50s, the National Board of Medical Examiners started to replace open-ended oral examinations with the "Multiple Choice Questions", which proved to be more objective, reliable and effective and were soon accepted worldwide. New educational tools were successively suggested as computer-aided simulation ("Computer Aided Instruction") for both learning and assessment phases. All the above mentioned methods are limited by the fact that they are unable to evaluate the field of gestures and behaviours of the future physician. In consideration of this limitation, new assessment tools as the "Standardized Patient" utilized in the context of "Objective Structured Clinical Examination" or "Simulated Clinical Encounter", were recently developed. There are still some problems regarding the elaboration of assessment standards able to provide uniformity in scoring. In addition the assessment tools utilized so far for the individual student do not provide predictivity on his/her outcome in the future medical practice. Nevertheless, there are still some perplexities on the use of a chart audit for the purpose of assessing individual competence and predicting future performance skill.