Assessment of clinical skill competency of medical postgraduate students – Recommendations for upcoming CBME curriculum for postgraduates

Direct observation of postgraduate medical trainees with actual patients by clinical faculty has traditionally been a standard tool to assess knowledge and skills in clinical subjects. By assessing and providing feedback to medical trainees performing a medical interview, physical examination, or counselling patients, faculty can facilitate budding physicians to have successful practice of medicine in their future. Despite the advances in clinical skills evaluation, direct observation has been a most popular and time tested method. However, observation of postgraduate medical students by faculty is very subjective and unfortunately often sporadic and non-standardized. Substantial amount of literature identifies several threats to its construct validity as an assessment tool. Although many tried to demonstrate methods to minimize those threats, there are many lacunae that remain inherent to direct observation method. Hence the need of the time is to relook at the observation as an assessment tool, instead of discarding the whole as inappropriate one. The authors initially made an effort to analyse the problems in present settings in India. After an extensive literature search authors advocate few additions and modifications to the existing system. Thus the present study not only highlights the pitfalls in the direct observation method but also suggests solutions for the problem.