An overview of Assessment

Aim of the presentation

• Define and conceptualise assessment

• Consider the purposes of assessment

• Describe the key elements of a good assessment

• Describe two main types of assessment

Definitions of assessment

• ‘… the process of documenting, often times in measurable terms, knowledge, skills, attitudes and beliefs.’

• ‘The classification of someone or something with respect to the worth’

Other words that can mean “assessment”

• Appraisal

• Categorisation

• Evaluation

• Judgement and value judgement

• Adjudication

• Estimation

In medical educational terms we can think of assessment as the process by which knowledge, skills and behaviours may be tested and judgments made

about competence or performance.

Purposes of Assessment

• Measuring competence

• Diagnosing a student’s/trainee’s problems

• Measuring improvement

• Showing the effectiveness of the curriculum/quality assurance

• Introducing curriculum change

• Identifying effective teaching

• Self-evaluation• Ranking• Motivation for teachers

and learners• Progress testing

(developmental measures of improvement)

• Deriving income

The principles of assessment

What should be assessed?

The curriculum and assessment

The curriculum & the outcomes should define assessments

The ideal assessment fits the curriculum

• In real life there is often a less than perfect match

• The objectives are not fully and transparently defined

• Students will define theirown “hidden curriculum” and may miss elements that are tested

Assessing all elements of the curriculum

A simple model

Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S67.

Knows

Shows how

Knows how

Does

Cognition

Behaviour

Knows

Shows how

Knows how

Does

The assessment pyramid

Knowledge: Written tests

Competence: OSCEs

Performance:Workplace

Knows

Shows how

Knows how

Does

The emerging assessment pyramid

Meta-cognition

Constructing a “good” test

U= Rx Vx Ex Cx A

U= utilityR= reliabilityV= validityE= educational impactC= costsA=acceptability

van der Vleuten (1996) The assessment of professional competence:developments,research and practical implications. Adv Health Sciences Education. 1 (1) 41-67

Reliability:If this test were administered again

would the results be the same?

• REPEATABILITY/REPRODUCABILITY– Would the assessors make the same

judgements?– Would a different set of questions result in a

significantly different score?– Were there other things that may have

influenced the result?

Validity: Does the test measure what it thinks it is measuring?

• Face validity– Does it look appropriate?

• Content validity– Does it only assess what you want to

assess?

• Criterion validity– Is it predictive of future performance?

Educational impact

Curriculum Assessment

StudentTeacher

From: Lambert Schuwirth

Issues that affect educational impact

• The content– What is taught and learned

• The format– Written, clinical

• Scheduling– When things happen

• Regulatory structure– Assessment rules & information

Cost

Balancing the cost/benefit

Acceptance

• Political issues and support within the faculty

• Acceptance by the students

• Perceptions of fairness

Models of assessment

Formative assessment

• Provides information to the candidates about their strengths and weaknesses

Summative Assessment

• A measure of an end point achievement

• Even summative tests can (and should) be formative

• Must be robust and defensible

Assessment guidelines to achieve a high utility index

Assessment guidelines

• Establish the purpose• Define what is to be tested• Blueprint to guide selection of items• Select most appropriate test method/format• Administration and scoring• Standard setting

Newble DI, Jolly B, Wakeford R, eds. The certification and recertification of doctors: issues inthe assessment of clinical competence. Cambridge: Cambridge University Press; 1994.

Using the guidelines at Sheffield• Establish the purpose

• Define what is to be tested

• Blueprint to guide selection of items

• Select most appropriate test method/format

• Administration and scoring

• Standard setting

• To graduate safe/competent junior doctors

• Outcome objectives for core clinical problems

• Assessments of knowledge & skills are blueprinted

• Range of tests used• Centralised assessment

management• Hofstee/borderline methods

Strategic management of assessment

Assessment Committee

Curriculum Committee

Phase 4Phase 3Phase 2Phase 1

Administrators/academics

Assessments used at Sheffield

• Formative– On-line weekly tests– Mini Cex

• Summative– Extended Matching Questions– Modified Matching Questions– Observed long cases– Objective Structured Clinical Examination– Professional behaviour– Assessments of Student Selected Components

Formative assessments

• Weekly on-line tests (EMQs)– Face-to-face feedback– On-line personal results and peer

performance

Formative assessments

• Mini Cex (Mini Clinical Evaluation Exercise)– USA: National Board of Medical Examiners– Performance testing in real practice– Multiple observations/multiple observers– Longitudinal assessment to assess

professional growth– Feedback is inherent in the assessment

method

Mini Cex

Excellent Satisfactory Borderline Unsatisfactory

History taking

Physical examination

Communication skills

Professionalism

Overall clinical competence

Summative assessments

• End of year tests of knowledge– Extended Matching Questions– Modified Essay Questions

• Tests of clinical competence– Observed long cases– OSCE

• Assessment of professional behaviour• SSCs – reports, presentations, essays,

posters, leaflets

Observed long case

• 2 Observed long cases during final clinical attachments

• Successful completion entry requirement for the OSCE

• A “mastery” test – may be repeated

OSCE

• Separated from knowledge test by 4 months• 12 stations

– History - 3 stations – Physical examination - 6 stations– Communication - 2 stations– X-ray interpretation – 1 station

Was: 15 stations 5 mins eachNow: 12 stations 10 mins each

• Checklist and global rating scoring

Professional behaviours

• Longitudinal assessment of professional behaviours to give reliability

• Assessed against outcome objectives and Good Medical Practice (GMC 2001)

• Borderline/unsatisfactory performance triggers interview

• Consistent poor performance may lead to review by Fitness to Practise committee and possible exclusion

Student Selected ComponentsSSCs

• 25% of the overall course

• Beyond the core curriculum (depth +/- breadth)

• Various modes of assessment

• Assesses generic skills, critical analysis, ethics, research skills, clinical understanding