LAUSR

Irrespective of nationality, this statement underscores the importance of undergraduate education, and its associated assessments, because the best and most cost-effective way to protect the public is to ensure that only the right individuals go on the professional register in the first place. For providers of undergraduate education, this distils down into the problem of how to ensure and demonstrate that our graduates are competent to practice. In undergraduate dental education, common approaches for demonstration of competency are grounded in the traditions of novice to expert learning (2). In this arena, becoming an ‘expert’ requires ten or more years of experience (3). Consequently, the traditional method for determining competency is the measurement of experience through counting the number and the quality of procedures completed (4). This approach has likely become widely accepted because it appears to have face validity; it is simple to do; progression decisions can easily be defended; it has endured the test of time; and it fulfils a crucial criterion for assessment, namely it is acceptable to stakeholders (5). Data to support the latter statement can be found through reference to the latest round of inspection reports by the UK General Dental Council (GDC) where a focus on, and a drive to increase, the numbers of individual procedures performed by undergraduate learners is still very evident (6). However, is this traditional approach still the best possible way of measuring competency considering the aforementioned changes in expectation over accountability, combined with advances in our understanding of pedagogy, and available technology? This paper aims to initiate debate over what should constitute best practice in the assessment of competence. From the evidence-base available we suggest that to truly establish competency sophisticated approaches for data collection, integration, and interpretation are likely to be needed to meet the demands and expectations of the 21st century. This is because the modern healthcare setting requires its professionals to be responsive and adapt to the ever-changing needs of patients (7). We suggest that in this setting, the important evidence underpinning competency is the longitudinal demonstration of the learner’s ability to independently and simultaneously manage all aspects of the activity being assessed for each patient, over a range of contexts, rather than simply measuring the amount of a specific activity or isolated facets of competency such as communication or professionalism. Furthermore, we will contend that decisions over progression will need to be made on a leaner-specific basis through the professional judgement, and consensus of a multidisciplinary expert panel following the objective analysis of large and fully integrated data sets.