1. LEVELS OF CLINICAL COMPETENCE [Cox, 1982] Raja C. Bandaranayake

2. LEVELS OF CLINICAL COMPETENCE  PREREQUISITES on which clinical ability will be based  COMPONENT CLINICAL ABILITIES form parts of the clinical task  COMPOSITE CLINICAL PERFORMANCE focuses on management of whole patient  COMPETENT PRACTICE focuses on management of a series of patients

3. PREREQUISITES  Knowledge structure, function, Abnormality  Skills communication, observation, percussion  Attitudes respect, honesty, persistence Pen-and-paper, Oral Observation Progressive assessment during clerkship

4. COMPONENT CLINICAL ABILITIES  Taking a history  Examining the abdomen  Generating diagnostic explanations  Establishing rapport  Explaining implications of illness Direct observation OSCE Checklists and rating scales Real or simulated patients Video review

5. COMPOSITE CLINICAL PERFORMANCE  Processes of:  perceiving  questioning  reasoning  selecting  interpreting  Outcomes:  diagnosis  management “Long case” during clerkships and in examinations Real or simulated patients Video review

6. COMPETENT PRACTICE Management of ward, clinic or practice over a period, which includes:  setting priorities  management of health care team  investigations  referral  consultation Progressive assessment during clerkship Simulated patients Self- and peer-review `Outcome measures recovery rates morbidity rates

7. KSA PREREQUI- SITES COMPONENT ABILITIES COMPOSITE PERFORMANCE COMPETENT PRACTICE LEVELS OF CLINICAL COMPETENCE

8. EXPECTED PERFORMANCE LEVEL AT GRADUATION 1. Diagnosis + Total Management 2. Diagnosis + Initial Management + Referral 3. Diagnosis + Emergency Management 4. Diagnosis + Referral 5. Prevention

9. PERFORMANCE INDICATOR PERFORMANCE CRITERION CRITERION-REFERENCED ASSESSMENT PERFORMANCE INDICATOR A variable which tells us the extent to which a particular ability exists. May be a: process indicator product indicator PERFORMANCE CRITERION The level to which the indicator should exist if we are to judge anyone as competent. Hence: CRITERION-REFERENCED ASSESSMENT