Medical Educator Minute: Assessment in Medical Education

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Historically, assessment in medical education consisted of written and oral exams of medical knowledge. However, contemporary medical education recognizes the complexity of assessment and offers multiple assessment methods to better capture the multidimensional nature of education. Some examples of modern assessment methods include the OSCE (Objective Structured Clinical Exam), the mini-CEX (Mini-Clinical Evaluation Exercise), and DOPS (Direct Observation of Procedural Skills). Competency-based medical education, as discussed in our last Medical Education Minute, utilizes measures of competence, such as milestones and EPAs, that begin with the final outcome in mind but include levels to capture progression toward the end goal.

When completing or reviewing an assessment, it’s important to keep the following in mind:

  • Who is doing the assessing, and what is their perspective grounded in? (e.g., Faculty member assessing a trainee may have a different frame of reference than a trainee completing a peer evaluation.)
  • What is being assessed?  (e.g., Assessing a trainee’s medical knowledge of HIV, a trainee’s skill level in performing a laparoscopic procedure, or a trainee’s competence in leading a family meeting all assess different dimensions of a physician.)
  • Does your assessment method align with what you intend to measure? (e.g., An in-training exam score may be a better measure of medical knowledge, whereas a milestone rating may be a better measure of a clinical skill.)

When considering competence in the clinical space, Miller’s Pyramid of Clinical Competence helps us visualize the progression toward competence and guides us in aligning our assessment methods with the intended outcome. This is important to consider, as assessment often drives learning. Trainees often focus on learning what they anticipate will be assessed, whether that is the differential diagnosis of fever in a newborn or communication skills when disclosing a difficult diagnosis. Clearly articulating our intended outcomes and how they will be assessed will help all of us provide more effective assessments that support our learners’ growth.

Further reading: AMEE guide No. 25. The Assessment of Learning Outcomes for the Competent and Reflective Physician.