The effect of in-training assessment on clinical confidence in postgraduate education.

INTRODUCTION: The literature on how in-training assessment (ITA) works in practice and what educational outcomes can actually be achieved is limited. One of the aims of introducing ITA is to increase trainees' clinical confidence; this relies on the assumption that assessment drives learning through its content, format and programming. The aim of this study was to investigate the effect of introducing a structured ITA programme on junior doctors' clinical confidence. The programme was aimed at first year trainees in anaesthesiology. METHODS: The study involved a nationwide survey of junior doctors' self-confidence in clinical performance before (in 2001) and 2 years after (in 2003) the introduction of an ITA programme. Respondents indicated confidence on a 155-item questionnaire related to performance of clinical skills and tasks reflecting broad aspects of competence. A total of 23 of these items related to the ITA programme. RESULTS: The response rate was 377/531 (71%) in 2001 and 344/521 (66%) in 2003. There were no statistically significant differences in mean levels of confidence before and 2 years after the introduction of the ITA programme - neither in aspects that were related to the programme nor in those that were unrelated to the programme. DISCUSSION: This study demonstrates that the introduction of a structured ITA programme did not have any significant effect on trainees' mean level of confidence on a broad range of aspects of clinical competence. The importance of timeliness and rigorousness in the application of ITA is discussed.

[Physicians' clinical skills after finishing internship]. / Laegers kliniske faerdigheder efter turnusuddannelsen.

INTRODUCTION: The aim of this study was to evaluate Danish interns' clinical skills after their internship in order to identify areas where systematic training is needed. This study was a follow-up of a previous study on a group of interns at the beginning of their internship. MATERIAL AND METHODS: A questionnaire listing 88 practical skills was posted to a group of trainees before and after internship. The interns were asked to rate their level of mastery in each skill on a scale 0-10, where 0 = not mastery/not competent and 10 = mastery/competent. RESULTS: In all, 74 out of 100 trainees returned the questionnaire. In 60 of the skills the trainees reported a higher level of mastery after internship and in 28 procedures the level of skill did not improve. Ten of these are procedures used in emergency settings. DISCUSSION: The reliability of self-reported clinical skills can be discussed, but it is a major concern that skills particularly in emergency procedures do not improve. There is a need to define clear objectives, implement structured training programmes, and assess skills in order to accomplish a reliable and sufficient level of competency.