A review of prevocational medical trainee assessment in New South Wales

Craig M Bingham and Roslyn Crampton
Med J Aust 2011; 195 (7): 410-412. || doi: 10.5694/mja11.10109
Published online: 3 October 2011

In New South Wales and other Australian states, medical graduates are given a conditional training (internship) registration in their first postgraduate year of training, and they must demonstrate satisfactory performance to qualify for general medical registration. In the past, medical registration was overseen by state medical boards, but in July 2010, a national registration scheme overseen by the new Medical Board of Australia was instituted.

Assessment processes vary in each state, but are based on assessments made by senior clinicians acting as term supervisors. So far, the Medical Board of Australia has endorsed the intern-assessment processes of each state, but a nationally consistent approach to internship standards is in development.1

In NSW, the training of interns (postgraduate year 1) and residents (postgraduate year 2) — collectively known as prevocational medical trainees — is overseen by the Clinical Education and Training Institute (CETI). CETI introduced new progress review forms for assessing prevocational trainees in January 2009. The new forms were intended to:

Here, we report a review of the new assessment forms.


Our sample of 3390 assessment forms included 1674 mid-term forms and 1716 end-term forms from 1072 trainees (about 83% of all prevocational trainees in NSW) from 43 of the 52 prevocational training sites.

Ratings of performance

On nearly 43% of end-term forms, trainees self-assessed their performance as “at expected level” on all 19 items. No trainees rated themselves as performing below expected level on any item at end of term. The item most likely to be rated at borderline by trainees was procedural skills (on 1.4% of end-term forms).

There was a strong correlation between trainee self-assessment and supervisor assessment. Supervisor ratings for individual rating items matched the trainee’s self-assessment 66.9% of the time, were higher by one point 26.3% of the time and lower by one point 3.1% of the time.

The sample included forms for 1046 trainees for whom there were one or more end-term assessments. One thousand and thirty trainees (98.5%) were rated by themselves and by their supervisors as performing at or above the expected level of performance on every item in every term. The Box shows the distribution of overall performance ratings by trainee self-assessment and supervisor assessment at mid term and end of term. The “below expected level” rating is virtually unused, and the “borderline” rating is rarely used. Further, at the end of term, supervisors are more likely to rate trainees as “above expected level” than “at expected level”.

On the summary overall performance rating at the end of term, only two trainees (in one term each; 0.2%) were assessed as performing below expected level by their supervisors. Eleven trainees (0.9%) were assessed as borderline.


We consider that there are four main reasons for assessing medical trainees:

How well does the NSW assessment process meet these purposes?

Formative assessment: the role of self-assessment

To provide safe and effective patient care, doctors must recognise their strengths and limitations. Most vocational training programs use self-assessment as a key part of their assessment process5-7 because skill in self-assessment is fundamental to self-directed continuing medical education, which in turn is essential for maintaining competence throughout a clinical career.

It has been noted that self-assessment has limitations.8 In our study, 43% of trainees rated their performance as “at expected level” on all 19 items. We have discussed this result with trainees. Many feel constrained by the potential implications of their self-assessment and deliberately opt for a safe but meaningless “straight down the line” set of ratings.

Received 2 February 2011, accepted 27 July 2011

  • Craig M Bingham1
  • Roslyn Crampton2

  • Clinical Education and Training Institute, Sydney, NSW.


Competing interests:

No relevant disclosures.


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