Assessing medical students for non-traditional competencies.

Assessing medical student competence in non-traditional domains can be challenging. Conventional methods of assessment are generally unsatisfactory. The authors discuss the approach taken at the Brown Medical School, USA to assess students at the beginner, intermediate, and advanced levels in the social and community contexts of health care - one of the nine abilities that comprise Brown's competency-based curriculum. At the beginner level, faculty use weekly field notes written by students about their experiences in community practice placements as the means for assessment. At the intermediate level, faculty assess students based on their completion of a project focused on a community health problem. At the advanced level, a screening process is used in which students first meet individually with a member of the assessment committee who determines if the student's efforts appear to meet the expected standards. If success seemed likely, then the student was encouraged to appear before the whole committee. The authors discuss the common use of subjective judgments at all three levels and the importance of diverse perspectives in achieving a consensus. Allowing students wide latitude in expressing themselves and their accomplishments helps to ensure success.