Resident competence assessment: Best practices

Competence can be defined as “the ability to do something well.” The goal of ophthalmology residency training is to produce competent ophthalmologists. To prove competence, appropriate assessment methods are required. These methods should follow certain principles of assessment. Teaching ophthalmologist's time is valuable and limited and often poorly or uncompensated. Thus any assessment should be as timeefficient as possible but still provide valid and reliable information. However, the easiest and fastest assessment methods (written tests) are not appropriate for assessment of skill. Additionally, performance is situation specific. Good performance on medical knowledge multiple choice test does not mean there will also be good performance in procedural skills or examination techniques. Thus situation specific assessments must be used. Assessment methods should be known by the residents and aligned with objectives and performance expectations. Assessments can also be a learning experience. This may not always be possible if the assessment is an examination that leads to passing or failing a course, rotation or residency. This type of assessment is known as summative feedback. On the contrary, formative feedback is assessment that is designed to improve performance and thus must be shared with the resident. The vast majority of assessments should be formative. In recent years a variety of ophthalmology-specific competency assessment tools have been developed. The International Council of Ophthalmology (ICO) offers the only internationally developed test of ophthalmic medical knowledge. The ICO examinations include both basic and advanced levels. The Ophthalmic Clinical Evaluation Exercise (OCEX) is designed to assess resident competence in evaluating a new patient. The teaching physician completes scoring in 33 categories that rate the residents ability to communicate effectively, perform a history and examination, and synthesize the information into a differential diagnosis and