When one appears unclear on finding the way forward, it is often worth looking back; history can offer us interesting insights. Could Osler help us?
One obvious solution would be to make the summative assessments more challenging, by redefining medicine’s culturally accepted notions of acceptable minimum competence for graduation to something more stringent. Would this help?
Another logical step would be to combine several assessments together making progress decisions on the cumulative performance in all the assessments. Would this help?
It therefore appears that the way forward is by careful design of the whole assessment programme, paying careful attention to its educational impact as well as the more traditional considerations of validity and reliability
When designing a programme of assessment, medicine arguably faces particular challenges because of the need for regulators to reassure the public that their doctors are competent. But could our clinical experience help us redesign assessment programmes?
The challenging conclusion of the research evidence is that, in many cases, learners will not be receptive to feedback that may be available after high-stakes assessments. The summative assessment culture is dominant and acts to stifle the learning potential available from assessments. Its dominance also makes any change of culture very challenging to implement, however necessary the change may appear. Possible ways of enhancing post-assessment feedback receptivity have been proposed.
Medical education needs a paradigm shift in the assessment and feedback culture. This should benefit teachers, students but, crucially, also patients who have much to gain from doctors who are open to receiving, interpreting and acting on feedback.