Clerkship assessment assessed

This article reviews consistent research findings concerning the assessment of clinical competence during the clerkship phase of the undergraduate med ical training programme on issues of reliability, validity, effect on train ing programme and learning behaviour, acceptability and costs. Subsequently , research findings on the clinical clerkship as a learning environment are discussed demonstrating that the clinical attachment provides a rather uns tructured educational framework. Five fundamental questions (why, what, whe n, how, who) are addressed to generate general suggestions for improving as sessment on the basis of the evidence on assessment and clinical training. Good assessment requires a thoughtful compromise between what is achievable and what is ideal. It is argued that educational effects are eminently imp ortant in this compromise, particularly in the unstructured clinical settin g. Maximizing educational effects can be achieved in combination with impro vements of other measurement qualities of the assessment. Two concrete exam ples are provided to illustrate the recommended assessment strategies.