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Criterion-Based Assessment in a Norm-Based World: How Can We Move Past Grades?
Anne G Pereira1, Majka Woods, Andrew P J Olson
1A.G. Pereira is associate professor and assistant dean for curriculum, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota. M. Woods is assistant professor and assistant dean for educational development, University of Texas Medical Branch, Galveston, Texas. A.P.J. Olson is assistant professor and clerkship director, Subinternship in Critical Care, Departments of Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota. S. van den Hoogenhof is director of operations, Assessment and Evaluation, Office of Medical Education, University of Minnesota Medical School, Minneapolis, Minnesota. B.L. Duffy is assistant professor and residency program director, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota. R. Englander is professor and associate dean for undergraduate medical education, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.
The US medical education system is transitioning to competency-based medical education. Undergraduate medical education (UME) needs direct observation assessments to effectively evaluate trainees, moving beyond traditional grading and exams.
Area of Science:
- Medical Education
- Health Professions Education
- Curriculum Development
Background:
- The US medical education system is shifting from time-based to competency-based models.
- Graduate Medical Education (GME) is further along in this transition, utilizing competencies, milestones, and Entrustable Professional Activities (EPAs).
- Undergraduate Medical Education (UME) faces challenges in adopting this model.
Purpose of the Study:
- To identify challenges in the UME transition to competency-based medical education.
- To highlight the need for improved assessment methods in UME.
- To advocate for the development and adoption of direct observation assessments.
Main Methods:
- Analysis of current assessment practices in UME.
- Identification of barriers to implementing competency-based medical education in UME.
- Review of existing frameworks like the physician competency reference set and Core EPAs.
Main Results:
- UME relies heavily on norm-based standards (grades, USMLE scores, dean's letters) and proxy assessments.
- There is an overemphasis on summative rather than formative assessments in UME.
- Key frameworks for UME outcomes assessment have been established.
Conclusions:
- UME must overcome reliance on traditional, indirect assessment methods.
- Developing and implementing direct observation assessments is crucial for UME's competency-based transition.
- Effective assessments predicting clinical performance are needed to facilitate the UME shift.