Cognitive Influences on Complex Performance Assessment: Lessons from the Interplay between Medicine and Psychology

The assessment of healthcare professionals is a critical determinant of patient safety and healthcare quality, playing both a gatekeeping function and a path toward performance improvement. Given the complexity of physician-patient interactions and the inadequacy of self-assessment for judging one's own strengths and weaknesses, medicine exemplifies a domain in which adequate assessment is dependent on the perceptions and perspectives of observers. Such perspectives are susceptible to influences that range well beyond the performance itself, offering an opportunity to consider how cognitive psychology can guide improved practices and how examination of psychological processes in real-world environments can inform thinking about cognition. In this target article I will provide an overview of the challenges facing health professional educators, the insights that have been gained from the application of cognitive psychology toward deriving solutions, and some reflections on the current state of the science and ongoing needs. These efforts lead to the conclusion that performance assessment protocols stand a better chance of success when they are designed to accommodate limitations of attentional capacity, working memory, and the idiosyncratic influence of prior experience rather than striving to change these fundamental aspects of human cognition through rater training or response form alterations.