The effect of in-training assessment on clinical confidence in postgraduate education Charlotte Ringsted, 1 Jane Pallisgaard, 1 Doris Østergaard 2 & Albert Scherpbier 3 INTRODUCTION The literature on how in-training assessment (ITA) works in practice and what educa- tional outcomes can actually be achieved is limited. One of the aims of introducing ITA is to increase trainees’ clinical confidence; this relies on the assumption that assessment drives learning through its content, format and programming. The aim of this study was to investigate the effect of introducing a structured ITA programme on junior doctors’ clinical confidence. The programme was aimed at first year trainees in anaesthesiology. METHODS The study involved a nationwide survey of junior doctors’ self-confidence in clinical per- formance before (in 2001) and 2 years after (in 2003) the introduction of an ITA programme. Respondents indicated confidence on a 155-item questionnaire related to performance of clinical skills and tasks reflecting broad aspects of competence. A total of 23 of these items related to the ITA programme. RESULTS The response rate was 377 ⁄ 531 (71%) in 2001 and 344 ⁄ 521 (66%) in 2003. There were no statistically significant differences in mean levels of confidence before and 2 years after the introduction of the ITA programme – neither in aspects that were related to the programme nor in those that were unrelated to the programme. DISCUSSION This study demonstrates that the introduction of a structured ITA programme did not have any significant effect on trainees’ mean level of confidence on a broad range of aspects of clinical competence. The importance of timeliness and rigorousness in the application of ITA is discussed. KEYWORDS education, medical, undergraduate ⁄ *methods; clinical competence ⁄ *standards; educa- tional measurement ⁄ *standards; anaesthesiology ⁄ education; questionnaires; Denmark. Medical Education 2004; 38: 1261–1269 doi:10.1111/j.1365-2929.2004.02018.x INTRODUCTION Many authors have described the potential of in- training assessment (ITA) in postgraduate education and a wide variety of assessment instruments for comprehensive ITA programmes have been sugges- ted. 1–4 Trainees in postgraduate education want ongoing supervision and feedback and on-the-job discussions with consultants. 5 They want algorithms for medical decision making, regular sign-offs in a competencies logbook, effective and strategic use of annual assessment, and the development of more objective instruments for use in psychomotor skills training and assessment. 5 However, the literature on how ITA programmes work in practice and what educational outcomes can actually be achieved is limited. 6 Assessment drives learning through its content, format and programming. 7 Introducing assessment in programme aspects that have not previously been part of the assessment curriculum might both increase trainees’ levels of competence and change their attitudes towards the importance of those aspects. 8 Similarly, introducing assessment might change clinical teachers’ practice such that they provide increased supervision in those aspects included in formal assessment. 9 One of the aims of introducing ITA is to increase trainees’ clinical confidence based on the assumption that knowledge assessment 1 Copenhagen Hospital Corporation Postgraduate Medical Institute, Bispebjerg Hospital, Copenhagen, Denmark 2 Department of Anaesthesiology, Herlev Hospital, Herlev, Denmark 3 Institute for Medical Education, Maastricht University, Maastricht, The Netherlands Correspondence: C Ringsted, Copenhagen Hospital Corporation Postgraduate Medical Institute, Rigshospitalet, DK-2100, Copenhagen; E-mail: charlotte.ringsted@rh.dk Ó Blackwell Publishing Ltd MEDICAL EDUCATION 2004; 38: 1261–1269 1261