Miller's Pyramid
Updated 2026-08-22
INTRODUCTION
English translation pending.
CORE DEFINITION
Miller's pyramid, proposed by George Miller for medical education, arranges assessment of professional competence in four ascending levels: knows, knows how, shows how, and does. The lower two levels concern knowledge and the ability to apply it, while the upper two concern demonstrated performance and actual practice. Its core proposition is that competence at one level does not imply competence at the next, so assessment must match the level being claimed. The key qualification is that the pyramid describes what is being assessed rather than a fixed sequence of learning, and the higher levels are harder to measure reliably because they depend on real settings.
SCAFFOLDING EFFECT
Reduce cognitive load
- Claim calibration: ask which level a stated competence actually reflects before accepting it. - Assessment design: match the evaluation method to the level you need to verify. - Gap probe: move a claim up the pyramid by requesting a demonstration or evidence of past practice.
Anchor fast decisions
Knowledge is cheap to test and easy to fake, while performance under real conditions is costly to observe and hard to simulate. Because each higher level adds constraints that lower levels never test, competence measured at the bottom systematically overstates ability at the top. Explicitly naming the level makes that gap visible.
MINIMUM ACTION
In progress 0/1Practice this model in one real situation:
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Source support: Explicit
- en.wikipedia.orghttps://en.wikipedia.org/wiki/The_assessment_of_clinical_skillsverified
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