Join us as we discuss assessment in medical education with Dr Arianne Teherani @arianneteherani. We review the overall goals of assessment, the history of how assessment has evolved to reflect the needs of our society, and best practices for optimal and equitable assessment.
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The overarching goal of assessment is to assess competence, getting a sense of what learners know around an individual competency. This has evolved over time as we learn more about effective techniques for assessment. There are many ways to do this, and it needs to adapt.
Assessments should be both formative and summative. We need to provide feedback as they progress to allow learners to improve along the way. There should be multiple opportunities to demonstrate knowledge and growth in different ways (Epstein 2007).
Formative assessments are lower stakes observations that occur along the way to help a learner progress.
Summative assessments evaluate the learner toward the end of a learning experience. An example of this is a shelf exam or board exam. These tend to be higher stakes and make sure certain knowledge is gained.
Carol Dweck’s work highlighted that the mindset with which a learner approaches an assessment event will impact their performance. Check out our episode on Growth Mindset for more on this. Research in medical students shows they are often performance oriented, and that shifting this to a growth orientation may be beneficial (Theard 2021).
The overall goal of medical education is to meet the needs of our society and patients, assessment needs to mirror this. There are many aspects to this; historically there was a strong focus on competencies of medical knowledge but that has evolved over time.
Professionalism competencies grew out of some high profile cases of unprofessional behavior in physicians. Dr Tehrani and other’s research found by reviewing medical student records there were warning signs ahead of time that a future physician may have trouble with unprofessional behaviors (Papidakas 2004). This has developed over time into core competencies which are integrated into medical education and assessment.
Similarly, communication became more high profile as an important skill of a successful physician, and is one of the ACGME competencies.
Advocacy as a core competency of a successful physician is of growing interest. The Canadian CanMEDs framework, which is also used in some other countries, includes being a patient advocate as one of their core competencies for a physician. In the US, assessment for patient advocacy does not occur frequently or consistently, and this is an evolving area of research (Griffiths 2021, Griffiths 2022).
Schools ideally should research the effectiveness of their approaches to assessment and disseminate this so we can continue to improve.
Best practices for all assessment systems in clinical teaching include frequent feedback based on direct observation, longitudinal relationships with attendings, and a focus on predefined expectations. Dr Teherani’s work has identified additional structures that can help reduce inequities:
Six components of an Equitable Assessment Structure
Inform and educate on best practices and advances in research. Get buy in from the top to make change.
Focus on competence and values to society and the institution. Use multiple assessments that are frequent, including both formative and summative assessments, as this can give a learner many opportunities to display their learning and development. Value growth.
Dr Arianne Teherani reports no relevant financial disclosures. The Curbsiders Teach report no relevant financial disclosures.
Teherani A, Ue F, Heublein M, Kryzhanovskaya E. “#22 Assessment in Medical Education.” The Curbsiders Teach Podcast. http://thecurbsiders.com/teach. October 11, 2022
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