Online and clinical assessment of intern competence in management of on-call scenarios

Assessment of intern competence has traditionally been performed via subjective evaluations from supervisors and mentors. In 2009, Beaumont Hospital piloted the first pre-registration postgraduate assessment for interns.All interns working in Beaumont Hospital were assessed (n=67). The examination comprised a clinical OSCE and online written assessment comprised of EMQs and MCQs. All assessment tools focused on evaluating competence of commonly encountered intern duties, specifically in management of on-call scenarios, prescription writing and coordination of takeover of care.Regarding on-call scenarios, a majority of students were able to correctly manage hypertension following stroke (63%), assessment of falls (75%), post operative pain management (65%), neutropaenic sepsis (63%) and hyperkalaemia (56%). However, appropriate management of common emergencies such as hypoglycemia (29%), identification of septic patients (37%) and pre-operative hypertension (19%) was less optimal. Overall scores in safe prescribing were significantly lower particularly in legal prescribing (8%), prescribing science (35%), and palliative prescribing (22%). The main problem identified in coordination of takeover of care was handover of inappropriate tasks.Interns are reasonably prepared for commonly encountered on-call scenarios but prescribing competence is a cause for concern.Takeover of patient care also needs to be formally addressed within the undergraduate curriculum.