T h e n e w e ng l a nd j o u r na l o f m e dic i n e
n engl j med 356;4 www.nejm.org
january 25, 2007
Malcolm Cox, M.D., and David M. Irby, Ph.D., Editors
Assessment in Medical Education
Ronald M. Epstein, M.D.
From the Departments of Family Medicine,
Psychiatry, and Oncology and the Roch-
ester Center to Improve Communication
in Health Care, University of Rochester
School of Medicine and Dentistry, Roch-
ester, NY. Address reprint requests to Dr.
Epstein at 1381 South Ave., Rochester,
NY 14620, or at ronald_epstein@urmc.
N Engl J Med 2007;356:387-96.
Copyright © 2007 Massachusetts Medical Society.
A s an attending physician working with a student for a week, you receive a form that
asks you to evaluate the student’s fund of knowledge, procedural skills, professional-
ism, interest in learning, and “systems-based practice.” You wonder which of these
attributes you can reliably assess and how the data you provide will be used to further
the student’s education. You also wonder whether other tests of knowledge and com-
petence that students must undergo before they enter practice are equally problematic.
In one way or another, most practicing physicians are involved in
assessing the competence of trainees, peers, and other health professionals. As
the example above suggests, however, they may not be as comfortable using
educational assessment tools as they are using more clinically focused diagnostic
tests. This article provides a conceptual framework for and a brief update on com-
monly used and emerging methods of assessment, discusses the strengths and
limitations of each method, and identifies several challenges in the assessment of
physicians’ professional competence and performance.
Compe tence a nd Per for m a nce
Elsewhere, Hundert and I have defined competence in medicine as “the habitual and
judicious use of communication, knowledge, technical skills, clinical reasoning,
emotions, values, and reflection in daily practice for the b