title: Linking assessment to learning: a new route to quality assurance in medical practice.
abstract: BACKGROUND
  If continuing professional development is to work and be sensible, an understanding of clinical practice is needed, based on the daily experiences of doctors within the multiple factors that determine the nature and quality of practice. Moreover, there must be a way to link performance and assessment to ensure that ongoing learning and continuing competence are, in reality, connected. Current understanding of learning no longer holds that a doctor enters practice thoroughly trained with a lifetime's storehouse of knowledge. Rather a doctor's ongoing learning is a 'journey' across a practice lifetime, which involves the doctor as a person, interacting with their patients, other health professionals and the larger societal and community issues.
  
  
  OBJECTIVE
  In this paper, we describe a model of learning and practice that proposes how change occurs, and how assessment links practice performance and learning. We describe how doctors define desired performance, compare actual with desired performance, define educational need and initiate educational action.
  
  
  METHODS
  To illustrate the model, we describe how doctor performance varies over time for any one condition, and across conditions. We discuss how doctors perceive and respond to these variations in their performance. The model is also used to illustrate different formative and summative approaches to assessment, and to highlight the aspects of performance these can assess.
  
  
  CONCLUSIONS
  We conclude by exploring the implications of this model for integrated medical services, highlighting the actions and directions that would be required of doctors, medical and professional organisations, universities and other continuing education providers, credentialling bodies and governments.
authors.affiliation: Department of Continuing Medical Education, College of Family Physicians of Canada, Mississauga, Ontario, Canada. rhj@cfpc.ca
authors.forename: R S
authors.initials: RS
authors.lastname: Handfield-Jones
authors.forename: K V
authors.initials: KV
authors.lastname: Mann
authors.forename: M E
authors.initials: ME
authors.lastname: Challis
authors.forename: S O
authors.initials: SO
authors.lastname: Hobma
authors.forename: D J
authors.initials: DJ
authors.lastname: Klass
authors.forename: I C
authors.initials: IC
authors.lastname: McManus
authors.forename: N S
authors.initials: NS
authors.lastname: Paget
authors.forename: I J
authors.initials: IJ
authors.lastname: Parboosingh
authors.forename: W B
authors.initials: WB
authors.lastname: Wade
authors.forename: T J
authors.initials: TJ
authors.lastname: Wilkinson
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003406:Credentialing / Q000592:standards*; D004502:Education, Medical, Continuing / Q000592:standards*; D006801:Humans; D007858:Learning; D010821:Physicians, Family / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*