Learning from OSLER

When one appears unclear on finding the way forward, it is often worth looking back; history can offer us interesting insights. One of the key concerns for stakeholders is that new programmes of assessment seem unfamiliar and therefore somewhat radical and fear-provoking. But are the proposals really that new and radical? More than one hundred years ago, Sir William Osler clearly understood the adverse effects arising from the dominant influence of a summative assessment culture on medical education. His eloquent words deserve detailed scrutiny. In an address to a London medical school, he said:

We make the examination the end of education, not an accessory in its acquisition. The student is given the impression that he is in the school to pass certain examinations and I am afraid the society in which he moves grinds this impression into the soul.

Among his suggested remedies are adding elements of what we would now call an assessment for learning culture, while not completely abandoning assessment of learning. His proposals include frequent observations and judgements made in the workplace. These assessments would be low stakes in nature, but count towards the final examination mark. This would result in the final, formal examination being an “amplification” of the multiple low stakes assessments. He even advocated substituting qualitative assessments for quantitative estimates. Although he does not explicitly use the term feedback, he cannot be criticised for this, as the term was not in use until much later. With regard to students persistently struggling, he advocated honest dialogue, recognising that it was kinder for them to change career at an early stage rather than “struggle on painfully and submit to humiliation”. He had even thought about the need to foster students’ agency, quoting a former colleague approvingly:

Let us emancipate the student, and give him (sic) the time and opportunity for the cultivation of his mind, so that in his pupillage he shall not be a puppet in the hands of others, but rather a self-relying and reflecting being.

His proposed assessment system would, he foresaw, have great benefits on students’ learning:

[This] would enable him (sic) to seek knowledge for itself, without a thought of the end, tested and taught day by day, the pupil and teacher working together on the same lines.

In recognition of successful change management strategies, he made clear that examiners would also benefit from the proposed changes:

It is much nicer to watch the gradual growth of a student’s knowledge and to get it out retail day by day than to drag it out wholesale at set times.

While accepting there were potential implementation challenges, he was nevertheless optimistic:

Reform is in our hands and should not be far off.

Sadly, the results of recent research demonstrate that the need for reform is still largely awaited, rather than a footnote in history. 

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