Summative assessment: a pilot project in the west of Scotland.

In the autumn of 1991 the Committee in General Practice of the west of Scotland region appointed a working party to investigate the possibility of developing a credible, valid and reliable programme of summative assessment for general practitioner trainees. The working group formulated a four-part package consisting of a multiple true-false paper, a trainee audit project, the trainers' judgement, and analysis of videotaped consultations. The reasons for the use of this selection of methods are discussed. It is suggested that a summative assessment process for trainees should make use of the trainers' considerable knowledge of the trainee, have an external component, be criterion referenced, have an element of continuous assessment, and involve direct assessment of clinical competence. A pilot study of assessment of clinical competence using videotapes of routine trainee consultations by 25 volunteer general practitioner assessors is described. A rating instrument for use in differentiating the competent from the not yet competent trainee is discussed. The working group and the group of videotape assessors came to the provisional conclusion that the use of videotaped consultations may be a valid and feasible method of assessing the competence of general practitioner trainees as part of a balanced summative assessment programme.