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)