Department of Anaesthesiology, School of Medicine, University of Auckland, Auckland, New Zealand.
Department of Anaesthesia and Perioperative Medicine, North Shore Hospital, Auckland, New Zealand.
Med Teach. 2024 Apr;46(4):528-536. doi: 10.1080/0142159X.2023.2260081. Epub 2023 Sep 23.
In this critical narrative review, we challenge the belief that single-moment-in-time high-stakes examinations (SMITHSEx) are an essential component of contemporary specialist training. We explore the arguments both for and against SMITHSEx, examine potential alternatives, and discuss the barriers to change.SMITHSEx are viewed as the "gold standard" assessment of competence but focus excessively on knowledge assessment rather than capturing essential competencies required for safe and competent workplace performance. Contrary to popular belief, regulatory bodies do not mandate SMITHSEx in specialist training. Though acting as significant drivers of learning and professional identity formation, these attributes are not exclusive to SMITHSEx.Skills such as crisis management, procedural skills, professionalism, communication, collaboration, lifelong learning, reflection on practice, and judgement are often overlooked by SMITHSEx. Their inherent design raises questions about the validity and objectivity of SMITHSEx as a measure of workplace competence. They have a detrimental impact on trainee well-being, contributing to burnout and differential attainment.Alternatives to SMITHSEx include continuous low-stakes assessments throughout training, ongoing evaluation of competence in the workplace, and competency-based medical education (CBME) concepts. These aim to provide a more comprehensive and context-specific assessment of trainees' competence while also improving trainee welfare.Specialist training colleges should evolve from exam providers to holistic education sources. Assessments should emphasise essential practical knowledge over trivia, align with clinical practice, aid learning, and be part of a diverse toolkit. Eliminating SMITHSEx from specialist training will foster a competency-based approach, benefiting future medical professionals' well-being and success.
在这篇批判性叙述评论中，我们对单一时刻高风险考试（SMITHSEx）是当代专业培训的重要组成部分这一观点提出了质疑。我们探讨了支持和反对 SMITHSEx 的论点，考察了潜在的替代方案，并讨论了变革的障碍。SMITHSEx 被视为能力的“金标准”评估，但过于侧重于知识评估，而没有捕捉到安全和胜任工作场所表现所需的基本能力。与普遍看法相反，监管机构并没有在专业培训中强制要求 SMITHSEx。虽然作为学习和专业身份形成的重要驱动力，但这些属性并不是 SMITHSEx 所独有的。危机管理、程序技能、专业精神、沟通、协作、终身学习、实践反思和判断等技能往往被 SMITHSEx 所忽视。其固有设计对 SMITHSEx 作为工作场所能力衡量标准的有效性和客观性提出了质疑。它们对学员的幸福感产生了不利影响，导致倦怠和差异。SMITHSEx 的替代方案包括在培训期间进行持续的低风险评估、在工作场所对能力进行持续评估以及基于能力的医学教育（CBME）概念。这些方法旨在更全面、更具体地评估学员的能力，同时提高学员的福利。专业培训学院应从考试提供者转变为全面的教育资源。评估应强调基本实践知识而不是琐事，与临床实践保持一致，促进学习，并成为多样化工具包的一部分。从专业培训中消除 SMITHSEx 将促进基于能力的方法，有利于未来医疗专业人员的福祉和成功。
