#22 Assessment in Medical Education

October 11, 2022 | By Era Kryzhanovskaya

With Arianne Teherani, PhD

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. 

Website | Instagram | Twitter | Subscribe | Swag! | Top Picks | thecurbsidersteach@gmail.com | Free CME!

Credits

• Producer/Writer: Era Kryzhanovskaya MD 
• Hosts: Era Kryzhanovskaya MD, Frances Ue MD
• Show Notes/Show Runner/CME: Molly Heublein MD
• Infographic: Andrew DeLaat
• Cover Art: Andrew DeLaat
• Editor:  Era Kryzhanovskaya MD / Molly Heublein MD
• Audio Editor: Clair Morgan of Nodderly
• Guest: Arianne Teherani, PhD

CME Partner: VCU Health CE

Show Segments

• Intro, disclaimer, guest bio
• Guest one-liner/ Best piece of advice
• Picks of the Week
• History of assessment
• Basics of assessment
• Professionalism
• Advocacy
• Equity
• Take home points
• How to make change
• Outro

Assessment Pearls

1. The overarching goal of assessment is to assess competence, getting a sense of what learners know around an individual competency.  Assessments should be both formative and summative.   There should be multiple opportunities to demonstrate knowledge and growth in different ways.
2. Assessment in medical education has and should continue to evolve as we consider what skills a physician needs in our society and what the literature demonstrates as best practices for assessment. 
3. Historically, assessment was focused on medical knowledge; now, we have expanded into competencies in communication and professionalism.  Keep an eye out for patient advocacy competencies down the line. 
4. Use Dr Teherani’s six best practices to improve equity in assessment. 

Assessment Notes

Assessment Basics

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.

Assessment for Learning vs Assessment for Mastery

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).

Assessments need to Adapt

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.

Equity in Assessment

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

1. Avoids comparison to peers
2. Values narrative assessments above ratings (Check out our earlier episode for tips on this)
3. Focuses on patient care that goes beyond medical knowledge
4. Values growth
5. Teaches educators or clinical supervisors how to mitigate bias
6. Appreciates a learner’s identity and background in their approach to patient care (Teherani 2020).

How to make change

Inform and educate on best practices and advances in research.  Get buy in from the top to make change.

Take Home Points

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.

Links

1. Frameworks for Internal Medicine by Dr Andre Mansoor
2. The Many Daughters of Afong Moy  by Jamie Ford
3. Griffiths EP, Tong MS, Teherani A, Garg M. First year medical student perceptions of physician advocacy and advocacy as a core competency: A qualitative analysis. Med Teach. 2021 Nov;43(11):1286-1293. doi: 10.1080/0142159X.2021.1935829. Epub 2021 Jun 21. PMID: 34151706.

Disclosures

Dr Arianne Teherani reports no relevant financial disclosures. The Curbsiders Teach report no relevant financial disclosures. 

Citation

Teherani A, Ue F, Heublein M, Kryzhanovskaya E. “#22  Assessment in Medical Education.”  The Curbsiders Teach Podcast. http://thecurbsiders.com/teach.  October 11, 2022