Selecting Authentic and Feasible Pass/Fail Assessments in Competency-Based Education: A Clinical Teacher's Toolbox

Area of Science:

• Medical Education
• Health Professions Training
• Assessment Design

Background:

• Competency-based education (CBE) shifts health professions training from time-based progression to criterion-referenced, pass/fail competence judgments.
• Designing scalable and defensible assessments is crucial for successful CBE program implementation.
• Existing assessment methods need evaluation for authenticity and feasibility in CBE.

Purpose of the Study:

• To present a comparative framework for selecting summative, pass/fail assessments in CBE.
• To analyze common assessment tools using authenticity and feasibility lenses.
• To guide educators in designing sustainable and defensible assessments for CBE.

Main Methods:

• Comparative framework using authenticity and feasibility criteria.
• Examination of various classroom-based and performance assessments (e.g., MCQs, OSCEs, simulations, video demonstrations).
• Assessment of tools against Miller's Pyramid and domains of competence, considering faculty workload, scalability, and AI vulnerability.

Main Results:

• Authenticity is a continuum based on task design and integration of knowledge, reasoning, and performance.
• Feasibility is determined by faculty workload, feedback capacity, calibration, scalability, and AI risks.
• Combining scalable written assessments with higher-authenticity methods provides upstream evidence for entrustment decisions.

Conclusions:

• A balanced approach integrating diverse assessment modalities is key for effective CBE.
• The framework aids in selecting repeatable, defensible, and sustainable pass/fail assessments.
• This guidance supports the successful implementation of competency-based health professions education.