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Core principles of assessment in competency-based medical education.
Abstract
The meaningful assessment of competence is critical for the implementation of effective competency-based medical education (CBME). Timely ongoing assessments are needed along with comprehensive periodic reviews to ensure that trainees continue to progress. New approaches are needed to optimize the use of multiple assessors and assessments; to synthesize the data collected from multiple assessors and multiple types of assessments; to develop faculty competence in assessment; and to ensure that relationships between the givers and receivers of feedback are appropriate. This paper describes the core principles of assessment for learning and assessment of learning. It addresses several ways to ensure the effectiveness of assessment programs, including using the right combination of assessment methods and conducting careful assessor selection and training. It provides a reconceptualization of the role of psychometrics and articulates the importance of a group process in determining trainees' progress. In addition, it notes that, to reach its potential as a driver in trainee development, quality care, and patient safety, CBME requires effective information management and documentation as well as ongoing consideration of ways to improve the assessment system.
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“Two recently implemented initiatives in medical education, competencybased medical education (CBME) [9][10][11] and programmatic assessment of learners, 12 have the potential to improve the practice of feedback by promoting frequent observation of learners, feedback conversations, and coaching for improvement.”
From The R2C2 Model in Residency Education: How Does It Foster Coaching and Promote Feedback Use? (2018) · cites this paper as [11]
In the citing paper
“Finally, they promote the longitudinal compilation of performance data to coach the learner's continuing development (assessment for learning) and to make evidence-based decisions about the learner's progress (assessment of learning).[11][12][13][14][15]”
From The R2C2 Model in Residency Education: How Does It Foster Coaching and Promote Feedback Use? (2018) · cites this paper as [11]
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“Summative decisions are made by teams (clinical competency committees or similar entities), based on multiple observations and information bits (Lockyer et al. 2017).”
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“This can aid fair assessment of competence, (Lockyer et al. 2017), but practical experience will also add salience to what can be abstract outcomes.”
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“Further, effective assessment needs effective information management and documentation, as well as continuous improvements to the assessment system [22].”
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How workplace‐based assessments guide learning in postgraduate education: A scoping review
Martin, L. J., Blissett, S., Johnston, B. K., Tsang, M., Gauthier, S. R., Ahmed, Z., & Sibbald, M. (2022) · Medical Education · doi:10.1111/medu.14960 · Cited by 29
Competency-based pharmacy education definition: What components need to be defined to implement it?
Daugherty, K. K., Chen, A. M. H., Churchwell, M. D., Jarrett, J. B., Kleppinger, E. L., Meyer, S. M., Nawarskas, J. J., Sibicky, S. L., Stowe, C. D., & Rhoney, D. H. (2023) · American Journal of Pharmaceutical Education · doi:10.1016/j.ajpe.2023.100624 · Cited by 31
Enk, A. V., & ten Cate, O. (2020) · Perspectives on Medical Education · doi:10.1007/s40037-020-00616-x · Cited by 26
Ahn, E., LaDonna, K. A., Landreville, J. M., Mcheimech, R., & Cheung, W. J. (2023) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-23-00204.1 · Cited by 25
Carraccio, C. L., Martini, A., Melle, E. V., & Schumacher, D. J. (2021) · Academic Medicine · doi:10.1097/acm.0000000000004075 · Cited by 25
Felthun, J. Z., Taylor, S., Shulruf, B., & Allen, D. W. (2021) · Journal of Educational Evaluation for Health Professions · doi:10.3352/jeehp.2021.18.11 · Cited by 25
Point-of-Care-ultrasound in undergraduate medical education: a scoping review of assessment methods
DeBiasio, C., Pageau, P., Shefrin, A. E., Woo, M. Y., & Cheung, W. J. (2023) · The Ultrasound Journal · doi:10.1186/s13089-023-00325-6 · Cited by 26
“While methods of assessment, including multiple-choice questions (MCQs) and technical skill evaluation such as objective structural clinical evaluations (OSCEs) have traditionally been used, an emerging approach of targeting multiple assessment methods to better measure POCUS skills and thereby competency has been sug…”
MethodEvaluating the Strengths and Barriers of Competency-Based Education in the Health Professions
Jarrett, J. B., Elmes, A. T., Keller, E., Stowe, C. D., & Daugherty, K. K. (2024) · American Journal of Pharmaceutical Education · doi:10.1016/j.ajpe.2024.100709 · Cited by 30
Ryan, M. S., Gielissen, K. A., Shin, D., Perera, R. A., Gusic, M. E., Ferenchick, G. S., Ownby, A. R., Cutrer, W. B., Obeso, V. T., & Santen, S. A. (2024) · Medical Education · doi:10.1111/medu.15291 · Cited by 24
“14 Due to growing interest around competency-based assessment across the continuum of training 15 – 17 and increasing uptake of the Core EPA framework for assessment across medical schools, 18 it is imperative to determine the validity and reliability of WBAs, particularly if they are used as a…”
BackgroundClement, E., Oswald, A., Ghosh, S., & Hamza, D. M. (2024) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-23-00210.1 · Cited by 24
Assessment Practices for Dietetics Trainees: A Systematic Review
Jamieson, J., Palermo, C. E., Hay, M., & Gibson, S. (2019) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2018.09.010 · Cited by 24
Bolster, M. B., Chandra, S., Demaerschalk, B. M., Esper, C. D., Genkins, J. Z., Hayden, E. M., Tan‐McGrory, A., & Schwamm, L. H. (2022) · Academic Medicine · doi:10.1097/acm.0000000000004660 · Cited by 24
GPT-4: the future of artificial intelligence in medical school assessments
Haruna‐Cooper, L., & Rashid, A. (2023) · Journal of the Royal Society of Medicine · doi:10.1177/01410768231181251 · Cited by 24
Shrivastava, S. R., & Shrivastava, P. S. (2019) · Family Medicine and Community Health · doi:10.1136/fmch-2018-000043 · Cited by 23
“Significant emphasis has been given to assessment and its principles in order to ensure that competent healthcare professionals are produced.(15) 16 In the current study, respondents gave due emphasis to the issues that CBME is student-friendly, allows gradation of students on a yearly basis and that it helps in the i…”
BackgroundMa, I. W. Y., Desy, J. R., Woo, M. Y., Kirkpatrick, A. W., & Noble, V. E. (2020) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-19-00531.1 · Cited by 22
“Recurrent workplace-based observations are essential to help trainees achieve competence and to support decision-making and judgments regarding their competence.(13,14) To date, multiple assessment tools for POCUS skills have been published, with varying amounts of validity evidence to support the interpretation of sc…”
BackgroundThe pharmacology course for preclinical students using team-based learning
Kim, D.-H., Lee, J. H., & Kim, S. A. (2020) · Korean journal of medical education · doi:10.3946/kjme.2020.151 · Cited by 22
“The primary aim of a standardized, high-stake assessment such as KMLE lies in the assessment of learning rather than individualized, formative assessment for learning [26].”
BackgroundCollaborative Development of Core Entrustable Professional Activities for Veterinary Education
Salisbury, S. K., Rush, B. R., Ilkiw, J. E., Matthew, S. M., Chaney, K. P., Molgaard, L. K., May, S. A., Bok, H. G. J., Hodgson, J., Frost, J. S., et al. (2020) · Journal of Veterinary Medical Education · doi:10.3138/jvme.2019-0090 · Cited by 22
King, E., Turpin, M. J., Green, W., & Schull, D. N. (2019) · Advances in Health Sciences Education · doi:10.1007/s10459-019-09891-8 · Cited by 21
Optimizing assessors’ mental workload in rater-based assessment: a critical narrative review
Paravattil, B., & Wilby, K. J. (2019) · Perspectives on Medical Education · doi:10.1007/s40037-019-00535-6 · Cited by 22
Ryan, M. S., Khan, A. R., Park, Y. S., Chastain, C. A., Phillipi, C. A., Santen, S. A., Barron, B., Obeso, V. T., Yingling, S. L., & Program, F. T. C. E. P. A. F. E. R. P. (2021) · Academic Medicine · doi:10.1097/acm.0000000000004222 · Cited by 21
Learner handover: Perspectives and recommendations from the front-line
Gumuchian, S. T., Pal, N. E., Young, M. E., Danoff, D. S., Plotnick, L. H., Cummings, B., Gomez-Garibello, C. A., & Dory, V. (2020) · Perspectives on Medical Education · doi:10.1007/s40037-020-00601-4 · Cited by 21
“The developmental lens of CBME models and the accompanying assessment approaches have led to an increased focus on learner handover, or ‘forward-feeding’, where information about learners is shared across educational phases, supervisors, and/or clinical placements [4, 5].”
BackgroundInfluentialLeroy, P. L. J. M., KRAUSS, B. S., Costa, L. R., Barbi, E., Irwin, M. G., Carlson, D. W., Absalom, A. R., Andolfatto, G., Roback, M. G., Babl, F. E., et al. (2024) · British Journal of Anaesthesia · doi:10.1016/j.bja.2024.07.036 · Cited by 20
Singh, T., & Shah, N. (2022) · Journal of Postgraduate Medicine · doi:10.4103/jpgm.jpgm_337_22 · Cited by 20
“[34,37] This is especially important when qualitative assessments are done to make high-stakes decisions.”
Metadata
- Authors
- Lockyer, J., Carraccio, C., Chan, M.-K., Hart, D., Smee, S., Touchie, C., Holmboe, E. S., Frank, J. R., & Collaborators, O. B. O. T. I.
- Affiliations
- University of Calgary (CA)
- American Board of Pediatrics, Chapel Hill, NC, USA;
- University of Manitoba (CA)
- University of Minnesota (US)
- Medical Council of Canada (CA)
- Accreditation Council for Graduate Medical Education (US)
- University of Ottawa (CA)
- Corresponding author
- Lockyer, Jocelyn
- ORCID
- Venue
- Medical Teacher
- Publisher
- Informa UK Limited
- Published
- 2017-06-03
- Volume
- 39
- Issue
- 6
- Pages
- 609-616
- ISSN
- 0142-159X (ISSN-L)
- 1466-187X
- OpenAlex
- W2623879525
- Cited by
- 493
- References
- 59
- Citations by year
- 2026: 36 · 2025: 40 · 2024: 69 · 2023: 78 · 2022: 66 · 2021: 75 · 2020: 57 · 2019: 36 · 2018: 29 · 2017: 6
- FWCI
- 32.74
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Medical Teacher (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Education › Innovations in Medical Education
- Social Sciences › Education › Student Assessment and Feedback
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Competency Development and Evaluation
- Keywords
- competency-based medical education, learning assessment, assessment for learning, assessor training, psychometrics, feedback, assessment system improvement
- MeSH terms
- Clinical Competence, Competency-Based Education, Education, Medical, Educational Measurement, Feedback, Humans, Learning, Psychometrics
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