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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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“[1] The Medical Council of India (MCI), the regulatory body for medical education from 2019 onwards, moved towards competency-based medical education (CBME) curriculum.”
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Mills, L. M., O’Sullivan, P., ten Cate, O., & Boscardin, C. (2022) · Medical Teacher · doi:10.1080/0142159x.2022.2138741 · Cited by 19
“2018), feedback is increasingly important for learner development (Gruppen et al. 2017; Lockyer et al. 2017); this creates opportunities to enhance or innovate approaches to feedback.”
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“In medical education, while conceding that rater training may not be able to overcome all limitations, researchers have argued that it remains warranted because, “assessment ability is acquired, not innate; it requires deliberate practice and refinement over time (Lockyer et al., 2017, p. 612).””
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“Ideally, the assessment work should be in alignment with the purposes of training programs and seek buy-in from relevant stakeholders.(22) From the third level of positioning analysis in Narrative 2, the trainee appears rather submissive in complying with the requirement from the assessment programme, regardless of it…”
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Developing National Conceptual Understanding to Describe Entry-to-Practice Dietetics Competence
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“Formative assessments should be used frequently throughout training to support education and track progress towards competence.(8,9) Higher-stakes summative assessments are used at points of transition, progression, or certification.”
BackgroundA qualitative study of Canadian resident experiences with Competency-Based Medical Education
Day, L. B., Colbourne, T., Ng, A., Rizzuti, F., Zhou, L., Mungroo, R., & McDougall, A. (2022) · Canadian Medical Education Journal · doi:10.36834/cmej.72765 · Cited by 16
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“This lack of direct observation was also reported by Upadhyaya and colleagues as a barrier to implementation of formative assessment in CBME.18 Furthermore, supervisors expressed that residents would seek EPA evaluations for activities which they knew they would “pass” rather than continuously requesting EPA assessmen…”
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on behalf of the Collaborators of the MERlin Mapping Group, Griewatz, J., Yousef, A., Rothdiener, M., & Lammerding‐Koeppel, M. (2020) · BMC Medical Education · doi:10.1186/s12909-020-1940-0 · Cited by 16
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“Value appraisals include intrinsic value, which relates to the subjective value of the activity, such as interest, enjoyment, and immediate relevance [8, 9], whereas utility value relates to the usefulness of the outcomes [10, 12].”
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St‐Onge, C., Lachiver, É. V., Langevin, S., Boileau, É., Bernier, F., & Thomas, A. (2020) · Medical Education · doi:10.1111/medu.14136 · Cited by 15
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“An article by Lockyer emphasizes the importance of multiple assessments with multiple assessors in CBME to ensure that assessment for learning is taken care of (15).”
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“However, studies have found that these expectations are difficult to achieve in reality due to inadequate knowledge of assessment of competency [31– 35].”
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Assessment in Undergraduate Competency-Based Medical Education: A Systematic Review
Gupta, S. K., & Srivastava, T. K. (2024) · Cureus · doi:10.7759/cureus.58073 · Cited by 13
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Real-world impact of the COVID-19 pandemic on the assessment of anaesthesiology residents
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Continuity of supervision: Does it mean what we think it means?
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“Assessment within competency-based medical education (CBME) requires direct observations of residents in authentic environments, multiple assessors, and several assessment strategies (Holmboe et al. 2010; Takahashi et al. 2015; Lockyer et al. 2017).”
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“Robust assessment and documentation of student expertise is integral for the effective implementation of competency-based medical education.(74) Assessment in medical education can be defined as the processes used to make judgements about the achievements of students over a course of study.”
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“Particularly, assessing competencies in real clinical environments has been a major barrier in the effective integration of CBME into medical education systems [5].”
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“[11,12] The assessment process in CBME is quite unique and thus in order to attain the desired objectives, the assessment has to be authentic and formative in nature.[13,14] In the present study, after each assessment, a constructive feedback was given to the PG student, and this was followed by the development of a s…”
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“Medical students continuously require assessment throughout their medical journey to identify their defects in knowledge and skills, recognize their strengths, and remediate in a non-threatening and productive way [6, 7].”
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A case for feedback and monitoring assessment in competency‐based medical education
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Assessment-Seeking Strategies: Navigating the Decision to Initiate Workplace-Based Assessment
Gauthier, S. R., Braund, H., Dalgarno, N., & Taylor, D. R. (2023) · Teaching and Learning in Medicine · doi:10.1080/10401334.2023.2229803 · Cited by 14
Medical School Resourcing of USMLE Step 1 Preparation: Questioning the Validity of Step 1
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‘Next steps are…’: An exploration of coaching and feedback language in EPA assessment comments
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“…that EPA comments are written in ways that are aligned with the primary goal of assessment in CBME: assessment for learning, whereby frequent, contextually-specific coaching feedback is provided to support professional development (Schuwirth and Van Der Vleuten 2011; Lockyer et al. 2017).”
BackgroundInvolving ophthalmology departmental stakeholders in developing workplace-based assessment tools
Braund, H., Dalgarno, N., McEwen, L. A., Egan, R. G., Reid, M.-A., & Baxter, S. A. (2019) · Canadian Journal of Ophthalmology · doi:10.1016/j.jcjo.2019.01.013 · Cited by 11
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Workplace‐based Assessment Data in Emergency Medicine: A Scoping Review of the Literature
Chan, T. M., Sebok‐Syer, S. S., Cheung, W. J., Pusic, M. V., Stehman, C. R., & Gottlieb, M. A. (2020) · AEM Education and Training · doi:10.1002/aet2.10544 · Cited by 11
“Other studies focused on the use of digital technology as a powerful tool to enhance data collection by facilitating real-time feedback and documentation of learner performance.17,34,37,52 Assessor training was also recognized as important and necessary for supporting facultydriven collection of learner assessment.37,…”
BackgroundInfluentialTraining Psychiatry Residents in Descriptive Psychopathology: A Systematic Review
Etxeandia-Pradera, J.-I., Martinez-Uribe, D., Pradas, F. B., Gonzalez-Piqueras, J.-C., Nácher, J., & Aguilar, E. J. (2021) · Psychopathology · doi:10.1159/000512791 · Cited by 11
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“Previous literature has speculated that there could be an additional burden on faculty with a new focus on high-frequency WBAs due to the increase in volume of assessments (Caverzagie et al., 2017; Ferguson et al., 2017; Harris et al., 2017; Lockyer et al., 2017).”
BackgroundInfluentialJacobsen, M. E., Nayahangan, L. J., Ghidinelli, M., Subramaniam, C., Hare, K. B., Konge, L., & Gustafsson, A. (2023) · The Journal Of Hand Surgery · doi:10.1016/j.jhsa.2023.05.012 · Cited by 10
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Effect of Detailed OSCE Score Reporting on Learning and Anxiety in Medical School
Daniels, V. J., Ortiz, S. S., Sandhu, G., Lai, H., Yoon, M. N., Bulut, O., & Hillier, T. (2021) · Journal of Medical Education and Curricular Development · doi:10.1177/2382120521992323 · Cited by 11
Postgraduate medical education: see one, do one, teach one…and what else?
So, H. (2023) · Hong Kong Medical Journal · doi:10.12809/hkmj235145 · Cited by 13
Assessment Methods in Medical Education
Sheriff, D. S. (2023) · Annals of SBV · doi:10.5005/jp-journals-10085-9124 · Cited by 10
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“” Furthermore, assessment ability is acquired and not innate.[40] Assessor training is hence an indispensable part of any assessment program.”
BackgroundMethodInfluentialLam, A. C. L., Tang, B., Lalwani, A., Verma, A. A., Wong, B. M., Razak, F. A., & Ginsburg, S. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-062264 · Cited by 9
The IToP-STEPS: A unique scholarship program to upskill teachers of psychiatry
Kishor, M. R., Menon, V., Vinay, H. R., Shah, H. R., Isaac, M., & Arun, M. (2023) · Indian Journal of Psychiatry · doi:10.4103/indianjpsychiatry.indianjpsychiatry_428_22 · Cited by 9
Is time really of the essence? Timeliness of narrative feedback in ophthalmology CBME assessments
Hanmore, T., Moon, C. C., Curtis, R., Hopman, W. M., & Baxter, S. A. (2023) · Medical Teacher · doi:10.1080/0142159x.2023.2274286 · Cited by 9
“Many resources for teaching expound on the importance of providing timely feedback (Ramani and Krackov 2012; Lockyer et al. 2017; Iobst and Holmboe 2020).”
BackgroundCastellanos-Ortega, Á., Broch, M. J., Barrios, M., Fuentes-Dura, M. D. C., Sancerni-Beitia, M.-D., Vicent, C., Gimeno, R., Ramírez, P., Pérez, F., & García-Ros, R. (2020) · Medicina Intensiva (English Edition) · doi:10.1016/j.medine.2019.12.011 · Cited by 9
Shrivastava, S. R., & Shrivastava, P. S. (2022) · Medical Journal of Babylon · doi:10.4103/mjbl.mjbl_13_22 · Cited by 9
Developing an Entrustable Professional Activity to Improve the Care of LGBTQ+ Youth
Roth, L. T., Cooper, M. B., Lurie, B., & Wueste, B. (2022) · Academic Pediatrics · doi:10.1016/j.acap.2022.09.006 · Cited by 9
Tutor, A. S., Escudero, E., Avila, M. D. N., Aranda, J. F., Torres, H., Yagüe, J. G., Borrego, M. J., Muñoz, Ú., Sádaba, M. C., & Sánchez‐Vera, I. (2023) · Frontiers in Physiology · doi:10.3389/fphys.2023.1212031 · Cited by 9
Pizzuti, C., Palmieri, C., & Shaw, T. J. (2023) · Journal of Continuing Education in the Health Professions · doi:10.1097/ceh.0000000000000534 · Cited by 12
Kim, Y., & Choi, H. (2021) · Korean journal of medical education · doi:10.3946/kjme.2021.201 · Cited by 9
“In addition, the ‘pre-set’ graduate outcomes provide the context to consider the learning support system and environment for the completion of learners’ learning and achievement of outcomes [5,6].”
BackgroundDoes direct observation influence the quality of workplace‐based assessment documentation?
Landreville, J. M., Wood, T. J., Frank, J. R., & Cheung, W. J. (2022) · AEM Education and Training · doi:10.1002/aet2.10781 · Cited by 9
Tractenberg, R. E., Wilkinson, M. R., Bull, A., Pellathy, T., & Riley, J. B. (2019) · PLoS ONE · doi:10.1371/journal.pone.0224593 · Cited by 9
“This is a function of the implicit nature of any developmental trajectory in the competencies; the MR-NP makes development explicit, and the PLDs were formulated specifically to conform to psychometric validity [34, 41].”
BackgroundCompetencies of undergraduate physiotherapy education: A scoping review
Shumba, T. W., & Tekian, A. S. (2024) · South African Journal of Physiotherapy · doi:10.4102/sajp.v80i1.1879 · Cited by 16
“…existing assessment (Harris et al. 2010), including strategies to assess the clinical competencies in the ever-changing medical education, characterised by the multidisciplinary approach among healthcare professionals, requiring patient safety, transparency and accountability (Lockyer et al. 2017).”
BackgroundMethodCurtis, W., Frey, J. B., Huang, S., Kennell, G. F., Mao, X. (., Maw, S., & Strunk, R. (2022) · Proceedings of the Canadian Engineering Education Association (CEEA) · doi:10.24908/pceea.vi.15963 · Cited by 8
The McMaster Narrative Comment Rating Tool: Development and Initial Validity Evidence
McGuire, A., Acai, A., & Sonnadara, R. (2023) · Teaching and Learning in Medicine · doi:10.1080/10401334.2023.2276799 · Cited by 8
Preparing for CBME: How often are faculty observing residents?
George, S. J. K., Manos, S., & Wong, K. K. (2020) · Paediatrics & Child Health · doi:10.1093/pch/pxz169 · Cited by 8
Assessment in Neurologic Education
Jones, L. K. (2018) · Seminars in Neurology · doi:10.1055/s-0038-1666982 · Cited by 8
Wang, X. R., Hillier, T., Oswald, A., & Lai, H. (2019) · Medical Teacher · doi:10.1080/0142159x.2019.1670339 · Cited by 8
“As medical training transitions to competency-based medical education (Lockyer et al. 2017), the concept of meeting benchmarks to mark educational progress will be increasingly adopted.”
BackgroundRatelle, J. T., Halvorsen, A. J., Mandrekar, J. N., Sawatsky, A. P., Reed, D. A., & Beckman, T. J. (2019) · Academic Medicine · doi:10.1097/acm.0000000000003114 · Cited by 10
Maw, S., Huang, S., Cree, D. E., Kennell, G. F., & James, W. (2021) · Proceedings of the Canadian Engineering Education Association (CEEA) · doi:10.24908/pceea.vi0.14934 · Cited by 8
Guía del tutor para planificar y gestionar la formación de los residentes
de Gaúna, P. R., & Morán-Barrios, J. (2022) · Educación Médica · doi:10.1016/j.edumed.2022.100713 · Cited by 8
Moreau, K. A., Eady, K., & Jabbour, M. (2019) · Canadian Medical Education Journal · doi:10.36834/cmej.56881 · Cited by 8
Evaluating feedback comments in entrustable professional activities: a cross-sectional study
Andreou, V., Peters, S., Eggermont, J., & Schoenmakers, B. (2024) · Journal of Medical Education and Curricular Development · doi:10.1177/23821205241275810 · Cited by 8
Ott, M. C., Apramian, T., Cristancho, S., & Roth, K. (2023) · Journal of Otolaryngology - Head and Neck Surgery · doi:10.1186/s40463-023-00649-2
“Entrustment ratings on EPAs also contribute numerous data points to assist competency committees in making summative decisions about learner progression [2, 3, 7–9].”
BackgroundInfluential
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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