Assessment in medical education: Evolving perspectives and contemporary trends

Assessment is an important part of the educational process. It influences students' learning. Traditionally, assessment has been used to measure the achievement of students for certification or selection. However, increasing attention is being paid to using formative assessment to improve learning. Miller's pyramid provides a good conceptual model to assess clinical competence by providing tiered levels of assessment. All levels of the pyramid need to be included in the assessment process. To be useful, assessment should be valid (measuring what it is supposed to measure), reliable (confidence in the results), acceptable (to various stakeholders), feasible and have a positive educational impact. The major attributes (validity and reliability) refer to judgements that we make from the assessment data and are not the inherent property of any test or tool. All validity is construct validity. There is often a trade-off between validity and reliability but an assessment which is low on one can still be useful by virtue of its being high on the other. No one tool is enough for assessing students and a combination of tools is preferred to get a composite picture of students' attainment. Assessment of knowledge is largely made by written assessment. The tests and questions should be contextual and look for application of knowledge rather than mere recall of facts. Assessment of clinical skills is done by traditional methods such as long and short cases and newer methods such as mini-clinical evaluation exercises, objective-structured clinical examinations, case-based discussions and portfolios. An adequate and representative sample of clinical tasks and direct observation of performance are the key to the validity and reliability of the assessment process. Faculty training is important for improving the quality of assessments.