Assessment of procedural skills and clinical judgment

Why assess judgment and not only technique?

A closure can be technically perfect and still be the wrong decision. Assessment that looks only at the hands misses the choices that matter most: whether to close, when, how, and when to refer. The Academy’s assessment framework, which is in development, is designed to look at both, across seven domains.

Its structure follows the logic of Miller’s pyramid, which distinguishes knowing, knowing how, showing how and doing (Miller, 1990). A learner can know the principles of a subcuticular suture and still not be able to show it on a model, or to choose it correctly in practice. Each level needs its own kind of assessment.

The seven domains

Knowledge

Understanding of wound biology, anatomy and the principles behind each clinical choice. It may be assessed with structured written questions built around clinical scenarios rather than isolated facts.

Technical skills

Tissue handling, closure technique and instrument use, observed directly. The framework may draw on structured direct observation with global rating scales, an established way of assessing procedural skill.

Clinical judgment

Choosing what to do, in what order and why, when the case is not a textbook one. It may be assessed through case discussions and scenario-based questions in which there is more than one defensible answer and the reasoning counts.

Patient safety

Anticipating risk, preventing avoidable harm and recognizing complications early. Safety is assessed as a behavior during practice as well as knowledge on paper.

Decision-making

Including the decisions not to close, not to intervene and to refer. Learners are asked to justify decisions, so that a correct choice made for the wrong reason can be identified.

Learner confidence

How prepared learners feel, measured alongside what they can demonstrably do. Confidence and competence can diverge, so confidence is never used as a proxy for skill.

Retention & transfer

Whether learning lasts over time and carries over into clinical practice. This domain requires follow-up after the course, and it will be studied once programs have run.

How will the programs themselves be evaluated?

Beyond assessing learners, the Academy plans to evaluate the programs. The plan is structured in levels: learners’ reaction to the program, what they learned, and whether their practice changed; effects on patients would be a later and more demanding question. This is a plan, not a result.

The methods and results of the pilot evaluation will be published on the research page whatever they show.