Six questions to ask about assessment

Published on 01/06/2015 by admin

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Last modified 01/06/2015

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28 Six questions to ask about assessment

An understanding of basic concepts and approaches will help you to do agood job.

The assessment of a student’s or trainee’s learning is important not only for the student or trainee but also for the teacher, the course organiser, the accrediting body and the public as the consumer. Important decisions are taken about students as a result of the scores they achieve in examinations. Teachers and the other stakeholders need to know if students have achieved the appropriate level of mastery to move on to the next part of their training programme and if, on completion of their training, they are competent to practise as a doctor in a particular context.

Although assessment is important, it is one of the most difficult areas in medical education on which to get agreement. What constitutes a fair examination and what are the criteria for passing a student? Assessment is an area in which there have been significant developments as to what constitutes ‘good practice’ and these will be highlighted in this chapter.

Assessment procedures have been criticised by students, by professional bodies and by those outside medicine. In a recent court case, a judge criticised a nursing school for a failure to identify in its assessment procedures a nurse who proved grossly incompetent and demonstrated unprofessional behaviour after she qualified. For the student, assessment may be seen as analogous to playing in a cricket match where the rules have not been clearly specified in advance and are constantly being changed by the umpire. Students may perceive the examiner as threatening and as someone whose aim is to catch them out and find fault with them (Figs 28.1 and 28.2).

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Fig 28.1 Students may perceive the examiner as threatening.

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Fig 28.2 Students may perceive the examiner as someone whose aim is to catch them out.

Problems with assessment are serious: students can walk away from bad teaching but they are unable to do so with assessment if they are to achieve the qualification they seek. That assessment is a key and integral part of curriculum development is often not recognised. Issues relating to assessment should be seen not only as a testing or measurement problem but as inextricably linked to the learning outcomes and teaching methods. Course design and assessment are inseparable.

When thinking about assessment it is useful to think about six questions:

1. Who should assess the student?

2. Why assess the student?

3. What should be assessed?

4. How should the student be assessed?

5. When should the student be assessed?

6. Where should the student be assessed?

It is important to think about the overall programme of assessment, including the tools used and how they are implemented, and not to overemphasise one aspect such as the psychometric properties of the assessment instruments.

Who should assess the student?

One reason why assessment is complex and the teacher’s responsibilities may be unclear is that there is a range of stakeholders involved. These include:

• international accrediting bodies

• national accrediting bodies such as the General Medical Council in the UK and, in the USA, The National Board of Medical Examiners

• professional bodies, for example the Royal Colleges in the UK and the National Boards in the USA

• the public and patients

• the individual school in which the student is enrolled

• the department or course committee responsible for teaching the subject

• the individual teacher

• the students themselves.

In medical schools in the UK, the assessment process is overseen by the General Medical Council (GMC) and the implementation is the responsibility of each medical school. Teachers from other schools serve as external examiners and participate in the development of the school’s examinations, their implementation and pass/fail decisions. In contrast, in North America and in some other countries there is a national examination which students are required to pass. Each approach has merits. A national examination, while setting national standards, may stifle innovation in individual medical schools (Harden 2009).

In medical practice, doctors have to take responsibility for assessing their own performance and keeping themselves up-to-date. Not all doctors have the necessary skills or recognise the importance of the responsibility. Students must be prepared for this as part of their undergraduate education with reinforcement throughout their postgraduate training. Problems with unreliability in self-assessment are well recognised and there may also be problems with how students react to the assessment of their own competence. On one occasion, we asked students to mark their own examination paper against a model answer. Some found the procedure so traumatic that they were unable to complete the process and to our surprise required counselling as a result. Training students to become doctors who are inquirers into their own competence, and who are comfortable with this, should be a learning outcome of the curriculum.

Increasing attention is being paid to peer assessment, and the evaluation of students by their peers against certain learning outcomes has become part of some institutions’ assessment strategy. This is particularly valuable in the assessment of attitudes where often the student body has a better understanding of individual students’ strengths and weaknesses than the teachers.

Why assess the student?

At an early stage in planning an assessment programme it is important to consider the purpose of the assessment. An assessment designed to certify a student’s competence to practise as a trainee doctor will be different from the assessment method used to review a student’s progress and provide feedback during course work. Traditionally, assessment has been described as either ‘formative’, where the main aim is to provide the learners with feedback about their progress, or ‘summative’ where the aim is to determine whether the learners have achieved the course objectives. This distinction has become blurred with the recognition that summative assessment can also be used to provide feedback to the learner and summative decisions may be based on evidence collected during the training programme.

The purposes that can be served by assessment include:

• Decisions as to whether the learner is ‘fit for purpose’.

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