Multifaceted Assessment in a Family Medicine Clerkship:

C linical competence is multifaceted and requires the integration of knowledge, skills, and attitudes.1 Its assessment also requires an integrated and multifaceted approach.2 Assessment of clinical competence should use a variety of instruments to provide a 360° picture of each learner’s development.2 However, if one accepts that competence is not just about possessing the required knowledge, skills, and attitudes but is more about integrating them in practice, assessment should not solely focus on assessing the components of competence but should include occasions where students can demonstrate their ability to use them together effectively.1 Like in other family medicine clerkships, students at our institution are assessed using a summative Objective Structured Clinical Examination (OSCE).3 The OSCE provides tasks requiring students to demonstrate the integration of knowledge, skills, and attitudes. However, by targeting complex performance, it is somewhat limited in the detail it can provide about specific components of the performance, which could be important for feedback purposes. This is particularly true regarding the process of clinical reasoning where the process is largely invisible and can only be inferred from certain behaviors exhibited during the OSCE (eg, the questions an examinee asks a simulated patient can reflect their underlying diagnostic hypotheses).4 Further, the case-specificity of clinical reasoning requires wide sampling of material for reliable judgments to be made.5 We therefore conducted a pilot study to examine the utility of adding other types of assessments, specifically targeted at clinical reasoning, during our family medicine clerkship. Because our concern was specifically about students’ ability to