Checklists for assessment and certification of clinical procedural skills omit essential competencies: a systematic review

Med Educ. 2008 Apr;42(4):338-49. doi: 10.1111/j.1365-2923.2007.02970.x.


Objective: To develop generic criteria for the global assessment of clinical procedural competence and to quantify the extent to which existing checklists allow for holistic assessment of procedural competencies.

Methods: We carried out a systematic review and qualitative analysis of published clinical procedural skills assessment checklists and enumerated the contents of each. Source materials included all English-language papers published from 1990 to June 2005, identified from 18 databases, which described or referred to an assessment document for any clinical procedural skill. A pair of reviewers identified key generic themes and sub-themes through in-depth analysis of a subset of 20 checklists with iterative agreement and independent retesting of a coding framework. The resulting framework was independently applied to all checklists by pairs of reviewers checking for the emergence of new themes and sub-themes. Main outcome measures were identification of generic clinical procedural skills and the frequency of occurrence of each in the identified checklists.

Results: We identified 7 themes ('Procedural competence', represented in 85 [97%] checklists; 'Preparation', 65 [74%]; 'Safety', 45 [51%]; 'Communication and working with the patient', 32 [36%]; 'Infection control', 28 [32%]; 'Post-procedural care', 24 [27%]; 'Team working', 13 [15%]) and 37 sub-themes, which encapsulated all identified checklists. Of the sub-themes, 2 were identified after the initial coding framework had been finalised.

Conclusions: It is possible to develop generic criteria for the global assessment of clinical procedural skills. A third and a half of checklists, respectively, do not enable explicit assessment of the key competencies 'Infection control' and 'Safety'. Their assessment may be inconsistent in assessments which use such checklists.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Certification*
  • Clinical Competence / standards*
  • Education, Medical*
  • Health Personnel / standards*
  • Research Design
  • Teaching / methods*
  • Teaching Materials