The development and testing of a structured trainer's report for summative assessment in general practice
The central theme of this thesis is the place of a report provided by the trainer on the performance of the trainee as part of a process of regulating entry to independent general medical practice in the United Kingdom (summative assessment). The thesis aims both to analyse the place of a such a report within a process of summative assessment and to consider whether it is possible to develop a report form for this purpose that enables aspects of the general practitioner trainee's skills, knowledge, attitudes and practice to be assessed by the trainer in a feasible, valid and reliable way. It is argued that the certification process for entry to independent general practice in the United Kingdom needs review and that tests of performance, such as a trainer's report, have a particular role in such a process; that such tests should be criterion-referenced; and that a number of properties are of particular importance in the development and testing of a trainer's report in the context of the assessment of doctors completing general practitioner training in the United Kingdom. A set of research objectives are delineated for a sequential series of five research studies. Using a variety of methods (semi-structured group interviews, postal questionnaire surveys, consensus conference, and pitot testing), these studies demonstrate: that there is a specific place for a trainer's report; that valid contents can be selected and minimum standards set; that the report form that has been developed is reliable and feasible and allows discrimination; and that, should it be widely adopted, there is a strong need for further testing, a continuing quality assurance system and further developmental work. It is concluded that summative assessment does have a role in providing an initial step in assuring the public of the quality of doctors entering independent general practice and that the report form developed here is suitable for wide application within such a process. It is also reasoned that a number of lessons about the application of such a process, and the inclusion of such a report, in other settings can be learnt. In particular it is suggested that a report provided by a trainer may have a particular role in assessment when the requirement is the assessment of performance of complex attributes within the context of training designed to enable the trainee to carry out a particular purpose but that it should rarely be used as the sole instrument.