EDITORIAL

Towards a new form of assessment in medical education: programmatic assessment

Hacia una nueva forma de evaluación en educación médica: la evaluación programática

Jordi Palés-Argullós

Fundación Educación Médica.
E-mail: jpales@ub.edu

In an editorial [1] written six years ago about the Bologna Process in this same publication, Professor Albert Oriol said that there were a number of reasons why the assessment of competencies was a huge challenge for universities. First, there was the lack of institutional experience in such undertakings, its inherent complexity and the shortage of resources available for carrying out such a task. He insisted on the fact that universities, and more particularly faculties of medicine, had an organisational structure divided up into departments that made it hard for them to migrate from a teaching system that was fragmented into subjects to one that was oriented more towards obtaining performance capabilities. Moreover, faculties had still not decided to set up interdepartmental educational support units with experience in assessment processes. Second, he said that it was necessary to take into account the fact that competencies are complex constructs of capabilities that are expressed in decision-making and in performance. We are thus before a series of behaviours that, in order to be assessed, often need to be observed by expert assessors under ideally standardised conditions, and not only on a sporadic basis but throughout the entire educational process.

Six years on and when the first student classes are graduating from university, in general terms little progress has been made in improving assessment practices and assessment remains a issue still pending resolution. Although all faculties of medicine in Spain have implemented an objective structured clinical evaluation (OSCE) at the end of the degree course and some of them have introduced new assessment instruments such as Mini-CEX, generally speaking we continue to assess in a fragmented way, in each discipline. A student graduates when he or she has successfully completed each of the individual subjects that go to make up the curriculum. But there is no progressive joint assessment of the acquisition of competencies nor an institutional programme of assessment that allows us to be sure that the final competencies established at the outset have been acquired to adequately. In general we still rely on the idea that an OSCE-type exam at the end of the degree and the rotating internship will provide us with enough information to certify that our graduates have acquired all the competencies. Yet, nothing could be further from the truth.

Assessment is one of the areas in which most research has been and is being conducted in medical education and the results reveal some basic principles that we should bear in mind. First of all, the concept of competence specificity which tells us that clinical competence is not generic and that a student or resident performs well in a particular situation or a certain post does not allow us to be sure that he or she will do just as well in another situation. This is why students need to be assessed at a number of different times throughout their training process, with different cases, instruments and a variety of observers. It is also necessary to have as much information as possible when it comes to making important decisions such as deciding whether a student passes or not, or graduates or not.

Another important aspect is the change of paradigm that is being defended in assessment: the shift from the assessment of learning to assessment for learning. This means that any assessment practice must be accompanied by the corresponding feedback, regardless of whether the aim of the assessment is formative or summative. Providing ongoing feedback will allow students to become aware of their level of acquisition of the competencies, of their progress, and will enable both us and them to take the right steps, if necessary, either to improve them or to correct them.

Finally, a concept that is becoming increasingly more common within assessment is that of programmatic assessment, a new holistic form of assessment that considers all the aspects outlined above. And in fact this is the title of the special article by Professor Van der Vleuten, from the University of Maastricht, an internationally acclaimed expert in assessment within medical education, included in this issue. It is undoubtedly an article that stresses what we have just commented on and which, from this editorial, we invite you to read so as to be able to start thinking about how to change our systems of assessment. I am sure you will not be disappointed after reading it.

References

1. Oriol-Bosch A. El reto de Bolonia: la evaluación de las competencias. FEM 2010; 13: 123-5.         [ Links ]