Miller’s pyramid of clinical competence was utilised explicitly for assessing students in health

care surroundings. It is beneficial for aligning learning outcomes (or clinical competencies)
with what learners should be able to do at any phase of the learning process (iDesign,
2022). Miller’s pyramid is often used with Bloom’s revised taxonomy, core competencies,
and entrustable professional activities (EPAs).

Miller’s pyramid model separates the development of clinical competence into four, tiered
processes (Ferns et al., 2019). On the bottom level of the pyramid is ‘knowledge’, tested by
written assessments and conventional multiple-choice questions
(MCQs). The next level stands for ‘application of knowledge’, measured
by essays, clinical problem-solving assignments and extended MCQs.
The third level of the pyramid represents ‘clinical skills competency’,
assessed by standardised patient exercises, recreations and clinical
exams. Lastly, on top of the pyramid is ‘clinical performance’, assessed
by direct analysis in a real clinical situation.
(BMC, 2014)

References:
BMC (2014) Miller’s pyramid of assessment of clinical skills, competence and performance,
Should essays and other “open-ended”-type questions retain a place in written summative
assessment in clinical medicine? BMC Medical Education. Available at:
https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-014-0249-2/figures/2
(Accessed: 24 March 2023).

Ferns, G., Scott-Smith, W. & Witheridge, A. (2019) “Revisiting Miller’s Pyramid in Medical
Education: The gap between traditional assessment and diagnostic reasoning,” International
Journal of Medical Education, 10, pp. 191–192. Available at:
https://doi.org/10.5116/ijme.5d9b.0c37

iDesign (2022) Miller's Pyramid of Clinical Competence, The iDea Book. Available at:
https://openpress.usask.ca/ideabook/chapter/millers-pyramid-of-clinical-competence/#:~:tex
t=Miller's%20pyramid%20of%20clinical%20competence%20was%20developed
%20specifically%20for%20assessing,stage%20of%20the%20learning%20process
(Accessed: 24 March 2023).