Introducing progressive assessment
With the return to profession-led community-based training, the RACGP has developed a nationally consistent progressive assessment framework, informed by current best practice in medical education and with input from a range of stakeholders. It builds on what has been working well in the vocational training programs, and aligns with the RACGP profession-led community-based training position paper and the RACGP educational framework.
To date, the focus has been on assessment of learning with the successful completion of the end point Fellowship exams being the corner stone of determining whether a candidate is competent to practice safely in unsupervised general practice. However, in keeping with current best practice in medical assessment more focus needs to be placed on assessment for learning and the integration of assessment within the training program. The introduction of a progressive assessment framework supports assessment for learning with frequent low-stakes assessments occurring over the course of training so that there are multiple opportunities for feedback and for registrars to demonstrate evidence of learning. Progressive assessment provides a more comprehensive review of the registrar’s capabilities and overall progress so that subsequent assessments can focus on areas of identified learning need.
A competency-based approach to medical education requires the assessment of a diverse range of competencies and professional attributes in addition to discipline-specific clinical knowledge and skills. This means that a greater emphasis needs to be placed on workplace-based assessment (WBA) as the main strength of WBA is its capacity to assess performance at the highest level of Miller’s pyramid, which represents the development of clinical competence according to a hierarchy beginning with knowledge and progressing to clinical performance.
A registrar needs to demonstrate sufficient progress in their competency development to advance from one stage of training to the next, acknowledging that each registrar will develop different competencies at different rates during training. A clear definition of the desired competency outcomes and progressive, frequent assessments throughout training will identify whether a registrar has made sufficient progress to advance to the next stage. Although our assessment framework will still assess across the full continuum of Miller’s pyramid of ‘knows’ to ‘does’, the focus of our assessments will be on the higher levels of Miller’s pyramid to support competency based medical education.
Figure 1 - Miller's Pyramid
Based on work by Miller GE. The assessment of clinical skills/competence/performance. Acad Med. 1990;65:S63–7.