Being able to drive a car has become a common activity of modern life that brings with it economic advantages and psycho-social benefits (e.g., protection, prestige and autonomy) to people. Sometimes driving a car is also the only option for individuals to ensure their mobility, for instance in residential areas with sparse public transport connections or for people that may have difficulties in mobility.

Comfortable and especially safe driving requires sufficient theoretical knowledge and practical skills for anyone wishing to cope with the hazards inherent to normal traffic. Additionally, and beyond the basic theoretical and practical skills, adequate driving performance requires a relatively healthy body and mind. These former two aspect are ‘trainable’ and are considered ‘competences’ and ‘skills’. The concept of ‘fitness’ is reserved for the latter ‘body and mind’ aspect. Driving competence and driving fitness, although obviously interrelated, hence have conceptually different meanings. Simply put, it is the difference between driving aspects that you ‘learn’ and aspects that you ‘are’.  

Both concepts are relevant and important aspects of safe driving and their combination results in driving behaviour or driving performance. Moreover, driving behaviour is also determined by the overall interaction between the driver, the vehicle and the external environment (Hunter et al., 2009). Hence, overall driving performance is determined by the combination of technical skills (for example theoretical knowledge of road safety and road traffic laws, vehicle handling), physical aspects (visual-spatial perception, hearing, locomotor coordination, control and muscle tone) and cognitive and personality aspects (attention, concentration, memory, reaction time, planning, judgment, coping strategy, attitudes) (National Transport Commission Australia, 2014). 

After having determined the concept of fitness to drive, we can now try to define it. We provide two definitions. Both provide an indication of the broadness van het concept.

• Fitness to drive is defined as “the state of having adequate physical, visual, and cognitive function, and no medical or behavioural contraindication to driving” (CIECA Fit to Drive meeting in London, July 2018).
• Fitness to drive is further defined by “the absence of any functional (sensory–perceptual, cognitive, or psychomotor) deficit, medical condition or personality characteristic that significantly impairs an individual’s ability to fully control the vehicle while conforming to the rules of the road and obeying traffic laws, or that significantly increases crash risk” (Transportation Research Board, 2016).

Previously we have defined driving competence and driving fitness as interrelated but different concepts, both ‘feeding into’ the driving performance. As fitness and competence are different concepts, they are also evaluated differently. In most countries, candidate drivers need to demonstrate the acquisition of driving skills in theoretical tests and practical on-road tests. Different to these tests, as the fitness aspect is related to health (body and mind), medical and psychological procedures are in place. For both competence and fitness aspects EU and national criteria have been determined: most countries have explicit criteria stating what needs to be examined in the theoretical and practical test and how many errors maximally are allowed. Also for the fitness aspect mental and physical standards (may) have been determined. 

The evaluation of competence aspects are referred to as ‘theoretical and practical tests’. The evaluation of the driving fitness aspect is referred to as the ‘fitness to drive assessment’. 

The presence of a health issue (illness or disability) disturbing one or more important functions for safe driving is not that uncommon. In these cases, the fitness to drive assessment will determine if it is advisable to start or resume driving or if adaptive strategies or interventions are needed to drive safely and comfortably (Marshall, 2008).

As fitness to drive is a comprehensive concept that includes pure medical, cognitive and even psychological aspects as for example personality and attitudes, the evaluation of the concept is comprehensive as well. It can therefor include medical, psychological and even practical driving  types of assessment. 

In this text we do not elaborate on medical and the psychological part of the fitness to drive assessment. We will focus on the practical driving part. 

Different from the driving test, i.e. the evaluation of driving competence and skill, the driving assessment is hence part of a comprehensive fitness to drive assessment and is usually performed additionally to medical and psychological assessments. This driving assessment, usually on-road, can be performed in addition to various types of off-road assessments (Marino et al., 2013).

It is generally recognised that this driving assessment is not just a mere observation of what happens while driving, but that medical or paramedical background is required to be fully  able to interpret and appreciate the observations in the light of the medical challenge (Dickerson, 2014). The driving assessment experts therefore need to be acquainted with the medical situation of the driver, the possible consequences and the available solutions both in terms of adaptation of the person, the environment and the vehicle (Shanahan, Sladek, & Phillips, 2007). As a matter of fact, they should have knowledge of the likely impairments that common medical conditions create that may impact on safe driving, or for less common conditions be able to access and understand such information (Lococo, Sifrit, Stutts, & Staplin, 2017). They should further be aware that technology exists to overcome physical impairments, if cognitive, psychological, behavioural, or other conditions do not create contra-indications.

In order to fully comprehend what a driving assessment is, we will compare it with the characteristics of a driving test. These contrasting characteristics are tabled below.

Firstly, as already stated, the driving assessment cannot be performed on its own. It is embedded in a comprehensive fitness to drive evaluation. This evaluation is by definition medical and psychological in nature. The driving test however, is embedded is an administrative procedure and as such it is more legally governed and relatively stand-alone. The driving test is usually considered the ‘final test’ before getting the driving licence. The driving assessment has not the merit of being the final stage in the fitness to drive procedure; it is merely a tool in the comprehensive fitness to drive evaluation. It will be used as an argument to take a final fitness to drive opinion. 

As the driving assessment is considering driving fitness and the driving test is considering driving competence, the experts involved have different tasks and titles as well. The driving assessment is performed by a driving assessor, whereas the driving test is performed by a driving examiner. The examiner observes the driving behaviour and evaluates ‘blindly’ the performance. The examiner will use pre-determined criteria, applicable to everyone at all times. The driving assessor however not just observes the driving behaviour but more importantly interprets the observations in the light of the medical, (neuro)psychological and perhaps even social background of the client. The evaluation is therefore not a blind evaluation. The background information sheds an important and even necessary light and helps to interpret the driving behaviour. For reasons of efficiency the driving assessor might even tailor the driving route in order to focus on the foreseen problematic driving aspects as indicated by the medical and psychological background of the client. As this is a more ‘personal and tailored assessment, the criteria used by the driving assessor can be considered more ‘individual’ in nature. 

The routes in the driving test are usually standard and determined on random basis. 

Related to that, the driving assessment does not require many preconditions as for example a driving licence or previous driving experience (although the latter certainly facilitates the evaluation and interpretation). In contrary, the person being submitted for a driving test needs to have at least previously succeeded in the theoretical test. As the driving test is embedded in the administrative procedure of obtaining a drivers’ licence, the results of this test are only pertinent for the type or category of vehicle in question. Contrary, the driving assessment results can eventually be extrapolated to other types of vehicles and mobility modes. Therefore, the driving assessment possibly has a much larger scope. 

In the eventuality of a ‘negative event’ during driving, the driving examiner will use the term ‘mistake’ or ‘error’ and the number of allowed mistakes is limited. The final outcome of the test is a pass/fail score as the goal is to verify whether the learner has achieved the defined training objectives. In a driving assessment this negative event is moreover ‘an interesting observation’ that needs further interpretation, as the driving assessor will try to understand the event, by looking for the reason and cause of the event in the search for a solution to it. If one of the problems for the client is of a physical nature, the choice of testing vehicle could also be limited, whereas in case of a driving test, the client can present in their   vehicle of choice. As in a driving assessment the assessor is ‘not blind’ to the situation of the client nor their background, as the driving route can be tailored as well as the vehicle and the conditions under which the evaluation can take place (for example the instructions or conversation while driving), the driving assessment can be considered a ‘guided tour’. Whereas the driving test is a more standardised event, and as such the client is more considered to be ‘on its own’. 

Hunter, J. A. A., Vries, J. de, Brown, Y., Brenner-Hartmann, J., Hekstra, A., & Vidmar, G. (2009). Handbook of Disabled Driver Assessment. Forum of Mobility Centres.

Transportation Research Board. (2016). Taxonomy and Terms for Stakeholders in Senior Mobility. Washington, D.C.: Transportation Research Board.

Marshall, S. C. (2008). The Role of Reduced Fitness to Drive Due to Medical Impairments in Explaining Crashes Involving Older Drivers. Traffic Injury Prevention, 9(4), 291–298.

Marino, M., de Belvis, A., Basso, D., Avolio, M., Pelone, F., Tanzariello, M., & Ricciardi, W. (2013). Interventions to evaluate fitness to drive among people with chronic conditions: Systematic review of literature. Accident; Analysis and Prevention, 50, 377–396.

Dickerson, A. E. (2014). Screening and assessment tools for determining fitness to drive: a review of the literature for the pathways project. Occupational Therapy in Health Care, 28(2), 82–121.

Shanahan, E. M., Sladek, R. M., & Phillips, P. (2007). Medical aspects of fitness to drive. What do public hospital doctors know and think? Internal Medicine Journal, 37(6), 372–376.

Lococo, K. H., Sifrit, K. J., Stutts, J., & Staplin, L. (2017). Medical Review Practices For Driver Licensing, Volume 3: Guidelines and Processes In the United States (No. DOT HS 812 402). Washington DC: National Highway Traffic Safety Administration