Table 1
Definitions commonly used in describing assessment programs in health professions education.
| TERM | DEFINITION | ILLUSTRATIVE EXAMPLE |
|---|---|---|
| Purpose | ||
| Assessment for learning [2, 3] | An assessment designed to serve primarily as a tool for learning. | Students are provided with an optional “self-assessment” in a course. The scores are provided to the student alone to plan for their growth in the program. |
| Assessment of learning [2, 3] | An assessment designed to serve primarily as a tool to determine how well the student has learned the material or achieved a level of skill or competence. | Students in a program are given a certification exam to determine whether they have mastered the content in their specialty. |
| Assessment as learning [4] | Assessments are incorporated into the learning process itself; assessments serve to self-regulate learning, reinforcing knowledge and skill acquisition. | Students are provided with multiple-choice questions and artificial-intelligence-enhanced feedback highlighting strengths, areas for improvement, and opportunities for self-reflection [6]. |
| Dual purposing [7] | Assessments are used for more than one purpose; typically, these purposes include a primary purpose and a secondary purpose, which are categorically different in their orientation toward promoting learning versus judging mastery of content. | Workplace-based assessments are used to guide learning during clinical rotations. These same data are then used at the conclusion of all rotations to determine whether students have met the competency threshold. |
| Stakes | ||
| High-stakes [11] | The assessment is given significant weight within the education program, and thus, the consequences for high and/or low performance are significant. | Students are required to pass an examination to advance to the next stage of their training. |
| Low-stakes [11] | The assessment is given a relatively low weight within the program; thus, its consequences are relatively insignificant. | Workplace-based assessments are administered in the authentic clinical settings. The data from each assessment is used as one of many data points in evaluating a student’s performance. |
| Purpose of assessment and learning | ||
| Formative [16, 71] | An assessment designed to serve primarily as a tool to contribute to the development or formation of the learner. This is commonly designed to promote learning during an educational experience. | Students receive midpoint feedback on their performance during a clinical rotation. |
| Summative [16, 71] | An assessment designed to serve primarily as a tool to determine how well the student has learned the material or achieved a level of skills or competence. This is commonly designed to measure learning acquired at the conclusion of an educational experience or where a progress decision is needed. | Students are evaluated on their performance at the conclusion of a rotation. |
| Assessment systems | ||
| Program of assessment [72] | The use of multiple assessments within the larger educational program to create a cohesive system of assessment; alignment between assessments and purpose is sought. | A medical education program selects a variety of assessment methods; some are designed to assess knowledge, while others are targeted at assessing communication skills. |
| Programmatic assessment [2, 26] | A specific program of assessment in which multiple data points are accumulated from multiple sources and then used to formulate a decision about a learner’s performance in a training program; focus is formative over summative; number of data points needed to make a decision is dependent on the stakes of the decision; a group makes high-stakes decisions of experts. | A competency-based program collects data from multiple-choice tests, workplace-based assessments, peer observations, and reflective writing assignments to determine whether a learner is competent for practice. |
Figure 1
The continuum of purpose and stakes of assessment with an illustration of “dual purposing” in a competency-based education program. Legend: This figure illustrates two prototypical assessments commonly used in competency-based health professions education: end-of-course multiple choice examinations and workplace-based assessments. The red dot indicates the primary use of the assessment while the blue dot indicates a secondary use (i.e., “dual purpose”) of the assessment. This figure illustrates how a lower-stakes assessment can become a higher-stakes assessment (dotted arrow) when that assessment (and others) are used in aggregate to formulate a summative competency decision. Of note, this figure is meant to provide a hypothetical example; the shift in purposes is illustrative of the concept rather than exact.
Table 2
Key considerations for effective “dual purposing” of assessments in a competency-based health professions education program.
| KEY CONSIDERATION | HOW TO DEVELOP THE COMPONENT | RISKS IF COMPONENT IS ABSENT |
|---|---|---|
| Setting the stage | ||
| Culture |
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| Communication |
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| Obtaining/Interpreting the data | ||
| Programmatic assessment |
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| Lower-stakes assessment |
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| Opportunities for data collection |
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| Technology |
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| Learner agency | ||
| Learner-initiated assessment |
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| Coaching relationships |
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| Ultra-low-stakes assessments |
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