Miller pyramid

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The Miller pyramid describes the development of clinical competence on four, hierarchical processes: 

  • The lowest level is knowledge (basis of the pyramid), assessed mainly by written exams (e.g., MCQs) 
  • The second level is the application of knowledge, assessed for example with  essays or oral assessments.
  • The third level is the clinical skills competency, assessed for example in OSCEs. 
  • The top of the pyramid is clinical performance, assessed with workplace-based exams 
  • Witheridge A, et al. Revisiting Miller’s pyramid in medical education: the gap between traditional assessment and diagnostic reasoning. Int J Med Educ. 2019;10:191-2. (Link)
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