An overview of Assessment

1. An overview of Assessment

2. Aim of the presentation • Define and conceptualise assessment • Consider the purposes of assessment • Describe the key elements of a good assessment • Describe two main types of assessment

3. Definitions of assessment • ‘… the process of documenting, often times in measurable terms, knowledge, skills, attitudes and beliefs.’ • ‘The classification of someone or something with respect to the worth’

4. Other words that can mean “assessment” • Appraisal • Categorisation • Evaluation • Judgement and value judgement • Adjudication • Estimation

5. In medical educational terms we can think of assessment as the process by which knowledge, skills and behaviours may be tested and judgments made about competence or performance.

6. Purposes of Assessment

7. Measuring competence • Diagnosing a student’s/trainee’s problems • Measuring improvement • Showing the effectiveness of the curriculum/quality assurance • Introducing curriculum change • Identifying effective teaching • Self-evaluation • Ranking • Motivation for teachers and learners • Progress testing (developmental measures of improvement) • Deriving income

8. The curriculum and assessment The curriculum & the outcomes should define assessments The ideal assessment fits the curriculum

9. Behaviour Cognition A simple model Does Shows how Knows how Knows Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S67.

10. The assessment pyramid Performance:Workplace Does Competence: OSCEs Shows how Knows how Knowledge: Written tests Knows

11. The emerging assessment pyramid Meta-cognition Does Shows how Knows how Knows

12. Constructing a “good” test

13. U= Rx Vx Ex Cx A U= utility R= reliability V= validity E= educational impact C= costs A=acceptability van der Vleuten (1996) The assessment of professional competence:developments, research and practical implications. Adv Health Sciences Education. 1 (1) 41-67

14. Reliability:If this test were administered again would the results be the same? • REPEATABILITY/REPRODUCABILITY • Would the assessors make the same judgements? • Would a different set of questions result in a significantly different score? • Were there other things that may have influenced the result?

15. Validity: Does the test measure what it thinks it is measuring? • Face validity • Does it look appropriate? • Content validity • Does it only assess what you want to assess? • Criterion validity • Is it predictive of future performance?

16. Educational impact Curriculum Assessment Teacher Student From: Lambert Schuwirth

17. Cost Balancing the cost/benefit

18. Acceptance • Political issues and support within the faculty • Acceptance by the students • Perceptions of fairness

19. Models of assessment

20. Formative assessment • Provides information to the candidates about their strengths and weaknesses

21. Summative Assessment • A measure of an end point achievement • Even summative tests can (and should) be formative • Must be robust and defensible

22. Assessment guidelines to achieve a high utility index

23. Assessment guidelines • Establish the purpose • Define what is to be tested • Blueprint to guide selection of items • Select most appropriate test method/format • Administration and scoring • Standard setting Newble DI, Jolly B, Wakeford R, eds. The certification and recertification of doctors: issues in the assessment of clinical competence. Cambridge: Cambridge University Press; 1994.

24. Using the guidelines at Sheffield • Establish the purpose • Define what is to be tested • Blueprint to guide selection of items • Select most appropriate test method/format • Administration and scoring • Standard setting • To graduate safe/competent junior doctors • Outcome objectives for core clinical problems • Assessments of knowledge & skills are blueprinted • Range of tests used • Centralised assessment management • Hofstee/borderline methods

25. Strategic management of assessment Curriculum Committee Assessment Committee Phase 1 Phase 2 Phase 3 Phase 4 Administrators/academics

26. Assessments used at Sheffield • Formative • On-line weekly tests • Mini Cex • Summative • Extended Matching Questions • Modified Matching Questions • Observed long cases • Objective Structured Clinical Examination • Professional behaviour • Assessments of Student Selected Components

27. Formative assessments • Weekly on-line tests (EMQs) • Face-to-face feedback • On-line personal results and peer performance

28. Formative assessments • Mini Cex (Mini Clinical Evaluation Exercise) • USA: National Board of Medical Examiners • Performance testing in real practice • Multiple observations/multiple observers • Longitudinal assessment to assess professional growth • Feedback is inherent in the assessment method

29. Mini-Cex History taking Physical examination Communication skills Professionalism Overall clinical competence

30. Summative assessments • End of year tests of knowledge • Extended Matching Questions • Modified Essay Questions • Tests of clinical competence • Observed long cases • OSCE • Assessment of professional behaviour • SSCs – reports, presentations, essays, posters, leaflets

31. Observed long case • 2 Observed long cases during final clinical attachments • Successful completion entry requirement for the OSCE • A “mastery” test – may be repeated

32. Professional behaviours • Longitudinal assessment of professional behaviours to give reliability • Assessed against outcome objectives and Good Medical Practice (GMC 2001) • Borderline/unsatisfactory performance triggers interview • Consistent poor performance may lead to review by Fitness to Practise committee and possible exclusion

33. Student Selected ComponentsSSCs • 25% of the overall course • Beyond the core curriculum (depth +/- breadth) • Various modes of assessment • Assesses generic skills, critical analysis, ethics, research skills, clinical understanding

34. What we don’t use Essays Viva-voce examinations MCQs Long cases as part of finals

35. OSCE • Separated from knowledge test by 4 months • 12 stations • History - 3 stations • Physical examination - 6 stations • Communication - 2 stations • X-ray interpretation – 1 station Was: 15 stations 5 mins each Now: 12 stations 10 mins each • Checklist and global rating scoring