title: Should we assess clinical performance in single patient encounters or consistent behaviors of clinical performance over a series of encounters? A qualitative exploration of narrative trainee profiles.
abstract: BACKGROUND
  A variety of tools have been developed to assess performance which typically use a single clinical encounter as a source for making competency inferences. This strategy may miss consistent behaviors. We therefore explored experienced clinical supervisors' perceptions of behavioral patterns that potentially exist in postgraduate general practice trainees expressed as narrative profiles to aid the grading of clinical performance.
  
  
  METHODS
  We conducted semistructured interviews with clinical supervisors who had frequently observed clinical performance in trainees. Supervisors were asked to describe which behavioral patterns they had discerned in excellent and underperforming trainees, during different stages of training, in their careers as clinical supervisor. We analyzed the interviews using a grounded theory approach.
  
  
  RESULTS
  The analysis resulted in a conceptual framework that distinguishes between desirable and undesirable narrative profiles. The framework consists of two dimensions: doctor-patient interaction and medical expertise. Personal values appear to be a moderating factor.
  
  
  CONCLUSIONS
  According to experienced clinical supervisors, consistent behaviors do exist in GP trainees when observing clinical performance over time. The conceptual framework has to be validated by further observational studies to assess its potential for making robust and fair assessments of clinical performance and monitor the development of consultation performance over time.
authors.affiliation: a Department of Family Medicine , Maastricht University , Maastricht , the Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Oerlemans
authors.affiliation: b Department of Primary and Community Care , Radboud University Medical Centre , Nijmegen , the Netherlands.
authors.forename: Patrick
authors.initials: P
authors.lastname: Dielissen
authors.affiliation: a Department of Family Medicine , Maastricht University , Maastricht , the Netherlands.
authors.forename: Angelique
authors.initials: A
authors.lastname: Timmerman
authors.affiliation: a Department of Family Medicine , Maastricht University , Maastricht , the Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Ram
authors.affiliation: a Department of Family Medicine , Maastricht University , Maastricht , the Netherlands.
authors.forename: Bas
authors.initials: B
authors.lastname: Maiburg
authors.affiliation: a Department of Family Medicine , Maastricht University , Maastricht , the Netherlands.
authors.forename: Jean
authors.initials: J
authors.lastname: Muris
authors.affiliation: c School of Health Professions Education , Maastricht University , the Netherlands.|d School of Medicine, Flinders University , Adelaide , Australia.|e University of the Witwatersrand , Johannesburg , South Africa.|f Curtin University , Perth , Australia.|g Northumbria University , Newcastle upon Tyne , UK.
authors.forename: Cees
authors.initials: C
authors.lastname: van der Vleuten
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D004521:Educational Measurement / Q000379:methods*; D058006:General Practice / Q000193:education*; D007407:Interviews as Topic; D009426:Netherlands; D010817:Physician-Patient Relations; D036301:Qualitative Research