n order to provide high-quality care in healthcare facilities, it is important to ensure that quality training, continuing professional development, and doctors’ clinical competencies are maintained. It is of utmost importance to learn from past untoward clinical incidents/ events in healthcare facilities. One of the ways to improve doctors’ clinical performance is through undergraduate and post-graduate teaching and assessment methods. These methods have evolved over many years. Curriculum development, which means defining the course structure and what outcomes are to be obtained, combined with course delivery (teaching and assessment methods), has a pivotal role in shaping a course/ programme and defining quality standards.

To address the performance problems, it is important to understand how a doctor’s competency is developed or maintained. For a doctor to be clinically competent and perform their duties effectively, the training programmes must be designed to assess professional functions at several levels.

Competency is defined as the ability to apply theoretical and practical (clinical knowledge) into clinical practice. Each discipline has a set of core competencies and specific competencies. Developing a competency requires the use of problem-solving skills and psychomotor skills. Both are complex skills that require developing or improving the way an individual processes information, as well as his/ her critical thinking and decision-making skills. Competencies are divided into knowledge, attitudes and practice (KAP). These are prerequisites for fulfilling a role as a doctor. A number of studies have been conducted on KAP, such as the KAP of evidence-based medicine among physicians. Such studies provide insight into areas that need improvement. If a survey identifies one or more of the three pillars (KAP) is found to be low among trainees or practicing doctors, then this can be addressed through various means.

Assessments drive learning. Assessments can be formative or summative. Formative assessments focus on improving students’ learning throughout the course. These evaluate students’ learning progression, identify any gaps in leaning and provide constructive and targeted feedback. Formative assessments help develop competencies in line with the defined curriculum. Summative assessments on the other hand check trainees’ knowledge and practical skills at the end of course. The method of evaluation helps identify competent individuals as it evaluates against a benchmark and identifies who moves up to the next level.

Assessments must take place at the end of medical school (undergraduate) or pre-clinical phase and through-out post graduates (clinical phase) training programmes. Clinical experiences of trainees i.e. volume of their clinical encounters and quality of supervision are two crucial components of assessments. Knowledge is an essential and common factor in all competencies.

In order to be in line with the current trends and needs of the medical profession and medical students, regular review of the curriculum and assessment processes must take place at degree-awarding institutions. For taught courses, feedback must be obtained from participants/ students. High-quality learning can only be achieved by creating a facilitating learning environment. This will promote professional growth. Students undergoing the assessment process must be supported. The capacity of academic faculty and supervisors to respond to changes in the curriculum must be addressed. There is no alternative to a well-structured training programme that has dedicated clinical and educational supervisors. Such programmes provide an opportunity for a trainee to improve their professional skills. One of the responsibilities of the supervisors is to identify ways to recognise and prevent poor performances among trainee/ resident doctors in clinical settings. This can be achieved through regular assessments of trainees’ performance and reviewing their progress while they are in the post. The provision of protected time for clinical supervision as part of structured training must be ensured to fulfill the requirements of the curriculum.

The writer is an associate professor in family medicine at Health Services Academy, Islamabad