Evaluation Frameworks, Assessment Forms, and Rating Scales

As noted in earlier chapters, assessing trainee performance in the care of “real” patients in actual practice settings is critical to effective evaluation. Central to this process is the faculty member who is the observer of the clinical care and of the specific interactions of the learner with a patient, the patient’s family, and other members of the healthcare team. Central to the concept of “competency-based” education is that observations and the judgments made about a learner’s progress and readiness for advancement are explicit, public, and demonstrable; further that they are applied with consistency and with sufficient sampling to ensure readiness for the next stage of professional development. This chapter concerns itself with how concepts of competence, rating scales, and other evaluation forms are intended to guide the observer in what to look for and how to interpret what is seen. It is now understood that the faculty observer is not a dispassionate servomechanism using the evaluation (assessment) rubric provided, but is engaged in a social judgment involving complex interactions1 and emotions that can also be affected by various biases. In other words, the problem of assessing learners in the clinical setting to achieve accuracy and equity2 is not simply cognitive (a choice of the rating rubric) but equally a social and emotional process for the teacher, as well as logistic in the time the faculty member has to observe the learner while at the same time ensuring the patient’s well-being. Central to this chapter is the understanding that the program or clerkship director cannot simply provide the teacher-rater with an evaluation form or rating scale and expect that summative judgments (e.g., assessment of learning) with good validity evidence can be made. We hope that reviewing the premises and uses of frameworks and forms will give program directors confidence in their process of providing feedback and in making advancement decisions..