In choosing skills assessment as the final topic of this series, I haven't saved the best for last--just the most intense. Skill assessment is intense for the student, for the evaluator and for the program.

Don't expect students to enjoy skill testing. Even capable, well-prepared students can display extreme discomfort at having their skills first evaluated by an instructor. Real-time, face-to-face evaluation is intimidating.

Skill assessment is just as intense for the instructor. The first rule is: don't react to a student's performance. Students are adept at reading your face and body language. Don't laugh, don't cry, don't get frustrated and, above all, don't help. Remember, the time devoted to any evaluation should assess learning. This should not be used as a teaching moment.

As with affective assessment, the lack of anonymity requires that your evaluation be based strictly on the objectives. Skills are best defined using a checklist that lists and orders all tasks of a procedure. These skill checklists should be given to the student for learning, and should be used by the evaluator in testing. Make sure that any time limitations for performance are included in the checklist and enforce those limits during testing.

Invariably the student will want immediate feedback. If you do not have time for a full debriefing, schedule at least five minutes to tell the student if their overall performance was satisfactory or not. Be sure to review the checklist and indicate which tasks were performed correctly and which were performed incorrectly.

Program administrators also find skill assessment to be daunting. Evaluating psychomotor skills requires more time, space and expertise than evaluating the students' cognitive skills.

Depending upon the skill set being assessed, an assessment may take from 20 minutes to an hour. In addition, to preserve the student's privacy, assessment requires a one to one student/preceptor ratio in a space that is separate from the other students. Finally, the presence of a knowledgeable and proficient clinician as preceptor is necessary to ensure a reliable evaluation.

Given the requirements for performing effective clinical skills assessments, it is no mystery that medical science programs are extremely expensive to administer.