What do you mean by "satisfactory"?

Introduction: One of the difficulties in designing assessment for medical trainees has been defining what is meant by "satisfactory". Whilst a list of "unsatisfactory" and "outstanding" characteristics can be identified with very little difficulty, it is the middle ground that holds the challenge. This is especially true in the non-technical areas of medical practice, which have been brought into greater prominence since the development and publication of CanMEDS 2000. As part of that process, questions about what is meant by "satisfactory", "standards" and/or benchmarks, have been brought into sharper focus. Additional questions are being asked as to whether competencies must necessarily be equated with minimum expectations or if they can be set, in conjunction with standards, to situate required "satisfactory" performance at a level significantly above a minimal level. Materials and Methods: A search of current literature on competencies and assessment was carried out. Results: From that analysis, it became evident that a definition of "satisfactory" in assessing competence is dependent upon the identification of underlying factors, including the kind of competence, the kind of knowledge, and the level of expertise required to match the standard of assessment. Conclusion: The varying definitions, expectations, and levels of "satisfactory" were mapped to illustrate a way to plot the level of "satisfactory" according to the task, the experience of the trainee, and the stage of training. This map also provides a method for developing shared understandings of the targeted level within the "satisfactory zone".