Assessment Fit for (More Than One) Purpose? Reconciling the Dual Purposes of Assessments in Competency-Based Health Professions Education
References
- Caretta-Weyer HA, Smirnova A, Barone MA, et al. The Next Era of Assessment: Building a Trustworthy Assessment System. Perspect Med Educ. 2024;13(1):12–23. DOI: 10.5334/pme.1110
- Schuwirth LWT, Van der Vleuten CPM. Programmatic assessment: From assessment of learning to assessment for learning. Med Teach. 2011;33(6):478–485. DOI: 10.3109/0142159X.2011.565828
- Schellekens LH, Bok HGJ, de Jong LH, van der Schaaf MF, Kremer WDJ, van der Vleuten CPM. A scoping review on the notions of Assessment as Learning (AaL), Assessment for Learning (AfL), and Assessment of Learning (AoL). Stud Educ Eval. 2021;71:
101094 . DOI: 10.1016/j.stueduc.2021.101094 - Carless D. Learning-oriented assessment: conceptual bases and practical implications. Innov Educ Teach Int. 2007;44(1):57–66. DOI: 10.1080/14703290601081332
- Dann R. Assessment as learning: blurring the boundaries of assessment and learning for theory, policy and practice. Assess Educ Princ Policy Pract. 2014;21(2):149–166. DOI: 10.1080/0969594X.2014.898128
- Sharif AF, Kasemy ZA, Aloshari SH. Assessment as Learning: A Mixed-Methods Study on Pre-Clinical Medical Student-Led Generation of Scenario-Based Multiple Choice Questions. Adv Med Educ Pract. 2025;16:1847–1859. DOI: 10.2147/AMEP.S549385
- Ginsburg S, Stroud L, Brydges R, Melvin L, Hatala R. Dual purposes by design: exploring alignment between residents’ and academic advisors’ documents in a longitudinal program. Adv Health Sci Educ Theory Pract. 2024;29(5):1631–1647. DOI: 10.1007/s10459-024-10318-2
- Schut S, Maggio LA, Heeneman S, van Tartwijk J, van der Vleuten C, Driessen E. Where the rubber meets the road — An integrative review of programmatic assessment in health care professions education. Perspect Med Educ. 2021;10(1):6–13. DOI: 10.1007/S40037-020-00625-W
- Watling CJ, Ginsburg S. Assessment, feedback and the alchemy of learning. Med Educ. 2019;53(1):76–85. DOI: 10.1111/medu.13645
- Kinnear B, Warm EJ, Caretta-Weyer H, et al. Entrustment Unpacked: Aligning Purposes, Stakes, and Processes to Enhance Learner Assessment. Acad Med. 2021;96(7S):
S56 . DOI: 10.1097/ACM.0000000000004108 - Lockyer J, Carraccio C, Chan MK, et al. Core principles of assessment in competency-based medical education. Med Teach. 2017;39(6):609–616. DOI: 10.1080/0142159X.2017.1315082
- Bok HGJ, Teunissen PW, Spruijt A, et al. Clarifying students’ feedback-seeking behaviour in clinical clerkships. Med Educ. 2013;47(3):282–291. DOI: 10.1111/medu.12054
- Crommelinck M, Anseel F. Understanding and encouraging feedback-seeking behaviour: a literature review. Med Educ. 2013;47(3):232–241. DOI: 10.1111/medu.12075
- Schut S, Driessen E, van Tartwijk J, van der Vleuten C, Heeneman S. Stakes in the eye of the beholder: an international study of learners’ perceptions within programmatic assessment. Med Educ. 2018;52(6):654–663. DOI: 10.1111/medu.13532
- Schuwirth L, Ash J. Assessing tomorrow’s learners: In competency-based education only a radically different holistic method of assessment will work. Six things we could forget. Med Teach. 2013;35(7):555–559. DOI: 10.3109/0142159X.2013.787140
- Downing SM, Yudkowsky R. Assessment in Health Professions Education. Taylor & Francis Group; 2009. Accessed October 11, 2024.
https://ebookcentral.proquest.com/lib/uva/detail.action?docID=425408 - Bok HGJ, Teunissen PW, Favier RP, et al. Programmatic assessment of competency-based workplace learning: when theory meets practice. BMC Med Educ. 2013;13:
123 . DOI: 10.1186/1472-6920-13-123 - Heeneman S, Oudkerk Pool A, Schuwirth LWT, van der Vleuten CPM, Driessen EW. The impact of programmatic assessment on student learning: theory versus practice. Med Educ. 2015;49(5):487–498. DOI: 10.1111/medu.12645
- Harrison CJ, Könings KD, Schuwirth LWT, Wass V, van der Vleuten CPM. Changing the culture of assessment: the dominance of the summative assessment paradigm. BMC Med Educ. 2017;17(1):
73 . DOI: 10.1186/s12909-017-0912-5 - Downing SM. Validity: on the meaningful interpretation of assessment data. Med Educ. 2003;37(9):830–837. DOI: 10.1046/j.1365-2923.2003.01594.x
- Dweck CS, Leggett EL. A social-cognitive approach to motivation and personality. Psychol Rev. 1988;95(2):256–273. DOI: 10.1037/0033-295X.95.2.256
- Dweck CS, Yeager DS. Mindsets: A View From Two Eras. Perspect Psychol Sci. 2019;14(3):481–496. DOI: 10.1177/1745691618804166
- Nichol H, Turnnidge J, Dalgarno N, Trier J. Navigating the paradox: Exploring resident experiences of vulnerability. Med Educ. 2024;58(12):1469–1477. DOI: 10.1111/medu.15426
- Kennedy TJT, Regehr G, Baker GR, Lingard L. Preserving professional credibility: grounded theory study of medical trainees’ requests for clinical support. BMJ. 2009;338:
b128 . DOI: 10.1136/bmj.b128 - Hattie J, Timperley H. The Power of Feedback. 2007. Accessed October 15, 2025.
https://journals-sagepub-com.proxy1.library.virginia.edu/doi/full/10.3102/003465430298487 - van der Vleuten CPM, Schuwirth LWT, Driessen EW, et al. A model for programmatic assessment fit for purpose. Med Teach. 2012;34(3):205–214. DOI: 10.3109/0142159X.2012.652239
- Hauer K, Goldhamer M, Amiel J, et al. The educational alliance: essential to implement competency-based health professions education. Perspect Med Educ., 2026;15(1):799–813. DOI: 10.5334/pme.2607
- Fuentes-Cimma J, Sluijsmans D, Riquelme A, et al. Designing feedback processes in the workplace-based learning of undergraduate health professions education: a scoping review. BMC Med Educ. 2024;24(1):
440 . DOI: 10.1186/s12909-024-05439-6 - Govaerts M. Workplace-Based Assessment and Assessment for Learning: Threats to Validity. J Grad Med Educ. 2015;7(2):265–267. DOI: 10.4300/JGME-D-15-00101.1
- Castanelli DJ, Weller JM, Molloy E, Bearman M. How Trainees Come to Trust Supervisors in Workplace-Based Assessment: A Grounded Theory Study. Acad Med J Assoc Am Med Coll. 2022;97(5):704–710. DOI: 10.1097/ACM.0000000000004501
- Trier J, Turnnidge J, McGuire CS, Côté J, Dagnone JD. It’s a “two-way street”: resident perspectives of effective coaching relationships in the clinical learning environment. Can Med Educ J. 2022;13(3):5–12. DOI: 10.36834/cmej.72940
- Norcini J, Burch V. Workplace-based assessment as an educational tool: AMEE Guide No. 31. Med Teach. 2007;29(9):855–871. DOI: 10.1080/01421590701775453
- Eva KW, Bordage G, Campbell C, et al. Towards a program of assessment for health professionals: from training into practice. Adv Health Sci Educ Theory Pract. 2016;21(4):897–913. DOI: 10.1007/s10459-015-9653-6
- Van Melle E, Frank JR, Holmboe ES, et al. A Core Components Framework for Evaluating Implementation of Competency-Based Medical Education Programs. Acad Med J Assoc Am Med Coll. 2019;94(7):1002–1009. DOI: 10.1097/ACM.0000000000002743
- van der Vleuten C, Lindemann I, Schmidt L. Programmatic assessment: the process, rationale and evidence for modern evaluation approaches in medical education. Med J Aust. 2018;209(9):386–388. DOI: 10.5694/mja17.00926
- Schuwirth LWT, Van der Vleuten CPM. Programmatic assessment: From assessment of learning to assessment for learning. Med Teach. 2011;33(6):478–485. DOI: 10.3109/0142159X.2011.565828
- Timmerman AA, Dijkstra J. A practical approach to programmatic assessment design. Adv Health Sci Educ. 2017;22(5):1169–1182. DOI: 10.1007/s10459-017-9756-3
- Govaerts M, Van der Vleuten C, Schut S. Implementation of Programmatic Assessment: Challenges and Lessons Learned. Educ Sci. 2022;12(10):
717 . DOI: 10.3390/educsci12100717 - Wilkinson TJ, Tweed MJ. Deconstructing programmatic assessment. Adv Med Educ Pract. 2018;9:191–197. DOI: 10.2147/AMEP.S144449
- Harrison CJ, Molyneux AJ, Blackwell S, Wass VJ. How we give personalised audio feedback after summative OSCEs. Med Teach. 2015;37(4):323–326. DOI: 10.3109/0142159X.2014.932901
- Harrison CJ, Könings KD, Dannefer EF, Schuwirth LWT, Wass V, van der Vleuten CPM. Factors influencing students’ receptivity to formative feedback emerging from different assessment cultures. Perspect Med Educ. 2016;5(5):276–284. DOI: 10.1007/S40037-016-0297-X
- Harrison CJ, Könings KD, Molyneux A, Schuwirth LWT, Wass V, van der Vleuten CPM. Web-based feedback after summative assessment: how do students engage? Med Educ. 2013;47(7):734–744. DOI: 10.1111/medu.12209
- Torre D, Rice NE, Ryan A, et al. Ottawa 2020 consensus statements for programmatic assessment –2. Implementation and practice. Med Teach. 2021;43(10):1149–1160. DOI: 10.1080/0142159X.2021.1956681
- Ten Cate O, Chen HC, Hoff RG, Peters H, Bok H, van der Schaaf M. Curriculum development for the workplace using Entrustable Professional Activities (EPAs): AMEE Guide No. 99. Med Teach. 2015;37(11):983–1002. DOI: 10.3109/0142159X.2015.1060308
- Marty AP, Linsenmeyer M, George B, Young JQ, Breckwoldt J, Ten Cate O. Mobile technologies to support workplace-based assessment for entrustment decisions: Guidelines for programs and educators: AMEE Guide No. 154. Med Teach. Published online January 27, 2023:1–11. DOI: 10.1080/0142159X.2023.2168527
- Ryan MS, Gielissen KA, Shin D, et al. How well do workplace-based assessments support summative entrustment decisions? A multi-institutional generalisability study. Med Educ. 2024;58(7):825–837. DOI: 10.1111/medu.15291
- Halman S, Rekman J, Wood T, Baird A, Gofton W, Dudek N. Avoid reinventing the wheel: implementation of the Ottawa Clinic Assessment Tool (OCAT) in Internal Medicine. BMC Med Educ. 2018;18(1):
218 . DOI: 10.1186/s12909-018-1327-7 - Krumm AE, Marcotte K, George BC. Model-Based Operative Performance Expectations for Quantifying Competency in General Surgery. JAMA Surg. 2023;158(5):515–521. DOI: 10.1001/jamasurg.2023.0014
- Lomis K, Pusic MV, Warm EJ, et al. Leveraging AI to accelerate competency-based education in the health professions. Perspect Med Educ, under review.
- Ganni S, Botden SMBI, Chmarra M, Li M, Goossens RHM, Jakimowicz JJ. Validation of Motion Tracking Software for Evaluation of Surgical Performance in Laparoscopic Cholecystectomy. J Med Syst. 2020;44(3):
56 . DOI: 10.1007/s10916-020-1525-9 - Perrone KH, Yang S, Mohamadipanah H, et al. Translating motion tracking data into resident feedback: An opportunity for streamlined video coaching. Am J Surg. 2020;219(4):552–556. DOI: 10.1016/j.amjsurg.2020.01.032
- Goldenberg MG, Jung J, Grantcharov TP. Using Data to Enhance Performance and Improve Quality and Safety in Surgery. JAMA Surg. 2017;152(10):972–973. DOI: 10.1001/jamasurg.2017.2888
- Kinnear B, Caretta-Weyer H, Lam ACL, et al. Finding Medicine’s Moneyball: How Lessons From Major League Baseball Can Advance Assessment in Precision Education. Acad Med J Assoc Am Med Coll. 2024;99(4S Suppl 1):S35–S41. DOI: 10.1097/ACM.0000000000005600
- Lomis K. The medical educator’s guide to projects leveraging artificial intelligence and learning analytics. American Medical Association. March 2025. Accessed January 9, 2026.
https://www.ama-assn.org/system/files/ai-educator-guide.pdf - Ten Cate TJ, Kusurkar RA, Williams GC. How self-determination theory can assist our understanding of the teaching and learning processes in medical education. AMEE guide No. 59. Med Teach. 2011;33(12):961–973. DOI: 10.3109/0142159X.2011.595435
- Raymond BL, Fowler LC, Robertson AC. The Impact of Converting From an “Educator-Driven” to a “Learner-Initiated” Feedback Model. J Educ Perioper Med JEPM. 2019;21(3):
E627 . DOI: 10.46374/volxxi-issue3-raymond - Ramani S, Könings KD, Ginsburg S, van der Vleuten CPM. Twelve tips to promote a feedback culture with a growth mind-set: Swinging the feedback pendulum from recipes to relationships. Med Teach. 2019;41(6):625–631. DOI: 10.1080/0142159X.2018.1432850
- Ahn E, Caverzagie K, Damodaran A, et al. No Environment, No Education: Honoring the Clinical Learning Environment as the Engine of Competency-based Education – A Call To Action. Perspect Med Educ. 2026;15(1):771–782. DOI: 10.5334/pme.2548
- Busari JO, Chan MK, Schwartz A, et al. CBE and the missing ‘E’: Making competency-based education an equitable framework for a majority-world health professions education. Perspect Med Educ., 2026; 15(1):880–893. DOI: 10.5334/pme.2551
- Branfield Day L, Miles A, Ginsburg S, Melvin L. Resident Perceptions of Assessment and Feedback in Competency-Based Medical Education: A Focus Group Study of One Internal Medicine Residency Program. Acad Med J Assoc Am Med Coll. 2020;95(11):1712–1717. DOI: 10.1097/ACM.0000000000003315
- Brand PLP, Jaarsma ADC, van der Vleuten CPM. Driving lesson or driving test?: A metaphor to help faculty separate feedback from assessment. Perspect Med Educ. 2021;10(1):50–56. DOI: 10.1007/S40037-020-00617-W
- Baartman L, Baukema H, Prins F. Exploring students’ feedback seeking behavior in the context of programmatic assessment. Assess Eval High Educ. 2023;48(5):598–612. DOI: 10.1080/02602938.2022.2100875
- Hall J, Oswald A, Hauer KE, Hall AK, Englander R, Cheung WJ. Twelve tips for learners to succeed in a CBME program. Med Teach. 2021;43(7):745–750. DOI: 10.1080/0142159X.2021.1925233
- Parsons AS, Kon RH, Plews-Ogan M, Gusic ME. You can have both: Coaching to promote clinical competency and professional identity formation. Perspect Med Educ. 2021;10(1):57–63. DOI: 10.1007/S40037-020-00612-1
- Telio S, Ajjawi R, Regehr G. The “educational alliance” as a framework for reconceptualizing feedback in medical education. Acad Med J Assoc Am Med Coll. 2015;90(5):609–614. DOI: 10.1097/ACM.0000000000000560
- Sargeant J, Mann K, Manos S, et al. R2C2 in Action: Testing an Evidence-Based Model to Facilitate Feedback and Coaching in Residency. J Grad Med Educ. 2017;9(2):165–170. DOI: 10.4300/JGME-D-16-00398.1
- Sargeant J, Lockyer JM, Mann K, et al. The R2C2 Model in Residency Education: How Does It Foster Coaching and Promote Feedback Use? Acad Med J Assoc Am Med Coll. 2018;93(7):1055–1063. DOI: 10.1097/ACM.0000000000002131
- Sargeant J, Lockyer J, Mann K, et al. Facilitated Reflective Performance Feedback: Developing an Evidence- and Theory-Based Model That Builds Relationship, Explores Reactions and Content, and Coaches for Performance Change (R2C2). Acad Med J Assoc Am Med Coll. 2015;90(12):1698–1706. DOI: 10.1097/ACM.0000000000000809
- Hamza DM, Hauer KE, Oswald A, et al. Making sense of competency-based medical education (CBME) literary conversations: A BEME scoping review: BEME Guide No. 78. Med Teach. 2023;45(8):802–815. DOI: 10.1080/0142159X.2023.2168525
- Lockyer J, Carraccio C, Chan MK, et al. Core principles of assessment in competency-based medical education. Med Teach. 2017;39(6):609–616. DOI: 10.1080/0142159X.2017.1315082
- Walsh K. Oxford Textbook of Medical Education. OUP Oxford; 2013. DOI: 10.1093/med/9780199652679.001.0001
- Norcini J, Anderson MB, Bollela V, et al. 2018 Consensus framework for good assessment. Med Teach. 2018;40(11):1102–1109. DOI: 10.1080/0142159X.2018.1500016
DOI: https://doi.org/10.5334/pme.2592 | Journal eISSN: 2212-277X
Language: English
Page range: 946 - 958
Submitted on: Mar 21, 2026
Accepted on: Jul 7, 2026
Published on: Sep 29, 2026
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
© 2026 Michael S. Ryan, Aleda M. H. Chen, Heather Nichol, Sören Huwendiek, Denyse Richardson, Benjamin Kinnear, Warren J. Cheung, Claire Touchie, Fremen Chihchen Chou, David A. Turner, Anna Oswald, As members of the International Competency-Based Health Professions Education Collaborative, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.