Integrated Strategies for Assessing Student Learning in Pre-Clinical Curriculum

A persistent challenge in pre-clinical education is bridging the divide between students' clinical-scientific understanding and their abilities to apply it in real patient care. Grounded in case-based learning and clinical competence frameworks, we designed a pre-clerkship medical curriculum centered around actual patient cases, structured case-based learning (CBL), and integrated assessments. While these strategies are often supported, little is known about how different assessments, ranging from written tests to direct faculty observations, work together to reflect students' growth in competence.

We examined integrated assessment data from 607 pre-clerkship cohort students across three consecutive academic years. Student competencies were evaluated through three outcome measures: (a) knowledge-based exams (KBE) that assessed clinical-scientific understanding, (b) problem-solving exams (PSE) that assessed diagnostic and analytical reasoning skills, and (c) faculty facilitator evaluations (FFE) that were based on direct observation of performance during the CBL discussions. Our analysis focused on trends in performance, relationships among assessment measures, differences across cohorts, and emerging competency profiles among students.

The findings show consistent performance between KBE and PSE assessments, with a slight downward trend over cohorts. Students who performed well on KBE tended to excel in PSE. In contrast, FFE showed greater variability in scores and appeared to capture additional competencies. The variation in FFE scores especially among students with otherwise similar performance may reflect evolving faculty assessment practices. Cluster analysis grouped three distinct competency profiles (advanced, commendable, and moderate competency groups) where the mean FFE score was most informative in the commendable competency group.

Our findings support the use of all three methods as a complementary assessment strategy within pre-clinical education. Notably, faculty observational assessment captures competencies not assessed by the other two modalities. The variability observed in the FFE performance also highlights the need to address its potential subjectivity. Future research should also investigate how these strategies relate to clerkship performance and how FFE particularly contributes to longitudinal competency mapping and learning support.