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Towards excellence in assessment in medicine: a commitment to a set of guiding principles
[Archive CMO Feature - Last updated: 15/12/03]

  • Last modified date:
    14 May 2007

The Chief Medical Officer has written to a number of organisations with a remit or interest in education and assessment in medicine, seeking their views on a Guiding Principles document drawn up by him after discussion with a small number of key stakeholders. Fifteen proposed principles are outlined in the consultation document 'Towards excellence in assessment in medicine: a commitment to a set of guiding principles'.

Assessment is now a major part of the process of assuring and improving the quality of medical training, of qualified doctors and so of clinical practice.  It is likely to become more so in the future.

Assessment is the formal measurement of performance by specially developed and validated methods for the purposes of classifying an individual against a standard. Assessment is used in a wide variety of contexts: in delivering educational curricula, in training programmes, in ensuring effective continuing professional development, in examinations for the award of degrees and professional qualifications, in judgements about the quality of health care provided, in measuring performance in post, in determining whether practice is meeting professional standards and job objectives, in determining competence and in determining fitness to practise.

Assessment of many different kinds is a process integral to the work of a large number of organisations in the health and health care arena in this country including: universities and training colleges, the General Medical Council, Royal Colleges and other professional organisations, the NHS and national agencies and independent bodies which support it.

In recognition of the importance of assessment for the quality and safety of professional practice and of health care more generally, the adherence to the principles of Good Medical Practice set out by the General Medical Council and acknowledging the range of organisations involved in assessment and the diversity of techniques involved, the Chief Medical Officer convened a series of informal meetings with some of the bodies concerned to discuss the issues.

Out of the discussions came the proposal to seek agreement on a set of principles which could then be promoted with the aim of encouraging the quest for excellence and consistency in all forms of assessment relevant to clinical practice and healthcare.

Set out below are the proposed principles.  They are initially for consultation.  Once finalised it is intended that all organisations involved in assessment should be invited to sign up to a commitment to achieving excellence in the assessment methods used in their fields of endeavour. Unless standards for assessment are set and implemented, then consistency and excellence will not be achieved. 

Proposed guiding principles

1.  The purpose of the assessment procedure is clear, well understood and well communicated.

2.  There is a consistent and effective relationship between the assessment process and the quality assurance and quality improvement goals being sought in the field of activity concerned: for example:

  • education and training;
  • continuing professional development;
  • clinical performance;
  • competency development.

3.  The format and design of the overall assessment system and its constituent methods are appropriate to what is being tested: for example:

  • clinical skills;
  • knowledge and decision-making;
  • interpersonal qualities;
  • competency in particular interventions;
  • communication skills.

4. The detailed assessment methods are: appropriate in content and method, valid, reliable, evidence-based and benchmark well against best-practice in other settings and other countries.

5. The detailed assessment methods are standardised in respect of: procedures for administering the test or assessment and using its results to classify and support trainees; in setting the standard for grades and pass/fail (where appropriate); in making observations or marking; in the format for recording and communicating the results of the assessment; in handling the component of the assessment process that relies on the professional judgment of the assessor.

6. It is clear that the overall assessment process and the detailed methods within it are criterion-referenced.

7. High quality documentation and quality assurance methods support the overall assessment system and the detailed assessment methods within it.

8. The overall assessment system and detailed methods within it are subject to quality assurance which is independent and external to those responsible for developing and managing them. 

9. The assessment is fair, transparent, well validated, free from discrimination and capable of recognising diversity.

10. Those carrying out assessments or tests and examinations (as part of the overall assessment process) should be fully trained and competent in them and should receive feedback on their performance.

11. It is rare for serious errors or misjudgements about those being assessed to occur but the process should build in feedback and a mechanism of appeal.

12. National assessments (e.g. examinations) should, as a minimum, test the knowledge, skills and attitudes that are necessary for effective and safe clinical practice.

13. National and local in-training assessments should, as a minimum, test the performance of the trainee in applying the competences tested by national examinations and in areas of diagnosis and patient management.

14. Patients and their representative organisations play an important part in the overall assessment system.

15. The relationship between national and local assessments is clearly defined.

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