For those involved in assessing clinical competence in the workplace, a review in Teaching and Learning on bias in rating clinical performance is a “must read.” Raters, the review says, form limited general impressions based on assessment of one or two dimensions, such as “clinical skills” and “professional behaviour.” Standards are idiosyncratic. Positive assessments of professional behaviour are reported more extensively than negative ones, leading to overgenerous evaluations. Training unfortunately has little impact on improving the accuracy and reproducibility of ratings. The conclusion seems clear. Traditional observation in the workplace is not a robust way to assess a doctor's competence to practise. It must be supplemented with other more objective structured clinical examinations.
Teaching and Learning in Medicine 2003;15: 270-92 [PubMed].