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The critical incident technique: a new approach to the assessment of clinical performance

The traditional clinical viva examination, which many schools still employ as the major method of assessing the clinical ability of their students, has repeatedly been shown to have serious deficiencies (McGuire, 1966; Pokorny & Frazier, 1966; Foster et aZ., 1969; Hubbard, 1971). Because of this, such examinations are often supplemented by ratings of the students’ performance on the wards or in other practice settings. Unfortunately, the variability of the judgement exercised by raters has also been shown to make this method a very unreliable form of assessment (Levine & McGuire, 1971). Concern about such problems has led to a search for new approaches to the measurement of the students’ clinical ability. Our own work has led us to develop the structured clinical examinations as a major component of our final-year examination (Newble & Elmslie, 198 1). Although we have established a high degree of validity and reliability with this approach as a measure of clinical competence (the capacity to perform), it does not provide a valid assessment of clinicalperformance in the real-life setting (Newble, Hoare & Elmslie, 1981). Our own attempts to obtain reliable ratings of ward performance were no more successful than those of other workers. We therefore decided to explore other