The assessment of clinical skills/competence/performance
Abstract
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Assessment authenticity is strengthened by requiring students to demonstrate practical skills in laboratory scenarios mirroring professional practice, while direct observation provides higher validity by evaluating actual competencies rather than written communication abilities.
“Assessment authenticity is strengthened by requiring students to demonstrate practical skills in laboratory scenarios mirroring professional practice, while direct observation provides higher validity by evaluating actual competencies rather than written communication abilities [15–17].”
From Clinical assessment meets laboratory science: adapting OSCE methodology for authentic biosciences evaluation in the age of generative AI (2025) · cites this paper as [15]
Based on Miller's Pyramid, 92.22% accuracy on MedQA benchmarks is a measure of the 'Knows' and 'Knows How' foundational levels of medical knowledge, rather than a surrogate for the 'Shows How' or 'Does' levels required for dynamic, real-world patient interactions.
“based on Miller’s Pyramid of Clinical Competence, it is critical to recognize that a 92.22% accuracy on MedQA benchmarks is a measure of the ‘Knows’ and ‘Knows How’ foundational levels of medical knowledge, rather than a surrogate for the ‘Shows How’ or ‘Does’ levels, which is required for dynamic, real-world patient interactions [40].”
From A Review of Multi-Agent AI Systems for Biological and Clinical Data Analysis (2026) · cites this paper as [40]
Miller's Pyramid of Clinical Competence serves as a valuable framework, emphasizing progression through four levels: 'knows,' 'knows how,' 'shows how,' and 'does.'
“Miller's Pyramid of Clinical Competence [49,50] serves as a valuable framework, emphasizing progression through four levels: 'knows,' 'knows how,' 'shows how,' and 'does.'”
From Formative assessment and feedback in medical education: A practical guide: AMEE Guide No. 189 (2026) · cites this paper as [50]
Miller's pyramid is the most frequently encountered variant of Bloom's work in medical education and can guide curriculum planning and assessment.
“In medical education, the most frequently encountered is Miller's pyramid (Kolb 1984).(Miller, 1990; Figure 3), which can be used as a guide for planning and assessing within a curriculum.”
From Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83 (2013) · cites this paper as Miller 1990
Assessment drives learning.
“it is widely asserted that ''assessment drives learning'' (Miller 1990)”
From Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83 (2013) · cites this paper as Miller 1990
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“Translated to psychotherapy, Miller (1990) proposed a framework for assessing the clinical skills as those that assess the therapist’s knowledge (does the therapist know what treatment is needed?)”
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“Assessment authenticity is strengthened by requiring students to demonstrate practical skills in laboratory scenarios mirroring professional practice, while direct observation provides higher validity by evaluating actual competencies rather than written communication abilities [15–17].”
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“…Competence, it is critical to recognize that a 92.22% accuracy on MedQA benchmarks is a measure of the ‘Knows’ and ‘Knows How’ foundational levels of medical knowledge, rather than a surrogate for the ‘Shows How’ or ‘Does’ levels, which is required for dynamic, real-world patient interactions [40].”
Influential
- Authors
- Miller, G. E.
- Corresponding author
- Miller, G E
- Venue
- Academic Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 1990-09
- Volume
- 65
- Issue
- 9
- Pages
- S63-7
- ISSN
- 1040-2446 (ISSN-L)
- OpenAlex
- W1991635648
- Cited by
- 4,883
- References
- 0
- Citations by year
- 2026: 326 · 2025: 269 · 2024: 290 · 2023: 308 · 2022: 332 · 2021: 330 · 2020: 302 · 2019: 297 · 2018: 252 · 2017: 257 · 2016: 237 · 2015: 243 · 2014: 211 · 2013: 179 · 2012: 175
- FWCI
- 4.46
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Academic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Social Sciences › Psychology › Social Psychology › Competency Development and Evaluation
- Keywords
- clinical skills assessment, competency assessment, performance evaluation (human resources), medical education, clinical competence
- MeSH terms
- Clinical Competence, Cognition, Educational Measurement, Humans, Patients, Role Playing, Students, Medical
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