Assessment Fit for (More Than One) Purpose? Reconciling the Dual Purposes of Assessments in Competency-Based Health Professions Education

Assessments serve several purposes in competency-based medical education (CBME) and competency-based health professions education (CBHPE) programs. These purposes are commonly termed ‘assessment for learning’ and ‘assessment of learning.’ Historically, educational scholars have advised against using an assessment for multiple purposes, arguing that doing so undermines its primary purpose. However, at times, such an approach may be required from a pragmatic standpoint. In this Eye Opener, the authors consider the competing purposes of assessment in CBHPE programs from a practical lens. They propose specific strategies to maximize benefits and minimize risks of dual-purposing when such an approach is necessary. First, the authors describe the importance of setting the stage for dual-purposing by creating a culture of trust, which requires clear institutional commitment to learner orientation and faculty development, infrastructure, and appropriate channels of communication with all constituents. Second, data considerations are discussed. The authors focus on adoption of programmatic assessment principles, opportunities for frequent formative observations, and strategies for leveraging available technology. Finally, the focus turns to the learner, highlighting their essential function as a key agent in driving their own growth and development. Balancing learner- and supervisor-initiated assessments, implementing longitudinal coaching programs, and considering “ultra-low-stakes” assessments are identified as mechanisms to support learner agency and development. Taken together, these specific design conditions may be used to promote learner growth and acquisition of competence when practical constraints require assessment data to serve a dual purpose.