Performance in assessment: consensus statement and recommendations from the Ottawa conference.

A modern approach to defining performance assessment in medical education requires recognition of the dynamic nature of the perspectives and definitions. These changes result from the variations in which clinical practice and education are delivered and a lack of clarity in defining competence and performance (Murphy et al. 2009). Competence describes what an individual is able to do in clinical practice, while performance should describe what an individual actually does in clinical practice. Clinical competence is the term being used most frequently by many of the professional regulatory bodies and in the educational literature (Miller 1990; Rethans et al. 2002; General Medical Council 2009). There are several dimensions of medical competence including the scientific knowledge base and other professional practice elements; such as history taking, clinical examination skills, skills in practical procedures, doctor–patient communication, problem-solving ability, management skills, relationships with colleagues and ethical behaviour (Epstein & Hundert 2002; General Medical Council 2003; Accreditation Council for Graduate Medical Education 2009). In the last 50 years, a wide range of assessment frameworks have been developed examining these different dimensions. Ensuring these are reliable and valid is, however, challenging (Schuwirth & Van der Vleuten 2006). Summary of group recommendations