Over the past decade, medical education has placed a renewed emphasis on assessment, focusing on ways to provide accurate, reliable, and timely assessments of the competence of trainees and practicing physicians. Such assessments have three main goals: to optimize the capabilities of all learners and practitioners by providing motivation and direction for future learning, to protect the public by identifying incompetent physicians, and to provide a basis for choosing applicants for advanced training.

Assessment can be formative (guiding future learning, providing reassurance, promoting reflection, and shaping values) or summative (making an overall judgment about competence, fitness to practice, or qualification for advancement to higher levels of responsibility).

Formative assessment
The goal of formative assessment is to monitor student learning to provide ongoing feedback that can be used by instructors to improve their teaching and by students to improve their learning. More specifically, formative assessments:

• help students identify their strengths and weaknesses and target areas that need work
• help faculty recognize where students are struggling and address problems immediately

Formative assessments are generally low stakes, which means that they have low or no point value.

Summative assessment
The goal of summative assessment is to evaluate student learning at the end of an instructional unit by comparing it against some standard or benchmark.

Summative assessments are often high stakes, which means that they have a high point value.

Selecting assessment methods
Selecting appropriate assessment methods is a complex process. Assessments must align well with the intended learning outcomes. Before selecting an assessment, faculty should first ask “What do I want students to be able to do after this learning experience?” (learning goals/objectives). Faculty should then as, “What would the resident have to do to convince me that he/she has achieved these goals?” (assessment).

Tools to help select assessment methods

The following tools can assist with selecting appropriate assessment methods:

ACGME Toolbox of Assessment Methods

ACGME Competencies: Suggested Best Methods for Evaluation

Interested in more? Try reviewing these resources:

Principles of Assessment

Formative vs. Summative Assessment: Quick Review
https://www.youtube.com/watch?v=mjmM1iN-m-E

Assessment in Medical Education: A Primer (PDF)

Five Strategies for Successful Assessment in Graduate Medical Education (PDF)

Assessment in Graduate Medical Education (PDF)

Clinical reasoning is the cognitive operations allowing clinicians to observe, collect, and analyze information that ultimately leads to an action (i.e., diagnosis and therapy). In other words, clinical reasoning provides an inclusive view of what is occurring in the clinical encounter. (Holmboe & Durning, 2004, "Assessing clinical reasoning: moving from in vitro to in vivo", Diagnosis)

Feedback is critical to learning and developing others’ talent. So what exactly is feedback? Feedback is defined as information that is communicated to a person about how well he/she is doing something, or what he/she might do differently to improve. Just as world-class athletes can’t improve and develop their talents without meaningful feedback on their performance from their coaches, the same is true for learners. As an experienced clinician, you are the expert to your resident’s novice. As such, your communication with the resident is very important. It is your responsibility to effectively communicate to your learner the standards required to practice medicine and how your learner is performing in relation to those standards. The goal of your feedback should be to improve your learner’s clinical decision making, provide reassurance of correct behaviors, and encourage improving what could have been done better.

Given the importance of feedback, it would be beneficial to provide learners with the best, most effective feedback possible, as that would most likely optimize resident learning. The following 3-minute video describes one effective feedback technique to help do just that, and is provided by the Virginia Apgar Academy of Medical Educators, a part of the Columbia College of Physicians and Surgeons.

Interested in more? Try reviewing these references:

Providing Educational Feedback
Twelve tips for giving feedback effectively in the clinical environment

Aligning your assessments and instructional activities with your learning objectives will increase the probability that learners will be provided opportunities to both learn and practice the knowledge and skills that they will be required to demonstrate.

To illustrate this point, watch this 3-minute video from the Virginia Apgar Academy of Medical Educators, a part of the Columbia College of Physicians and Surgeons

Interested in more? Try reviewing this reference:

Putting it all together - Presentation

Every program, course, or training activity begins with a goal. This goal can then be broken down into specific, measurable steps that should be taken to meet the goal. In the process of learning, these steps are called learning objectives, and they define what learners will know and be able to do at the end of a learning experience.

Learning objectives should have 4 parts (CABD approach):

1. Condition – describes the condition(s) in which your learners will perform or what they need to do first
2. Actor – describes the learner (PGY1? PGY2?)
3. Behavior – describes what the learners will be able to do after completing your activity. This is where you use an action verb, like those outlined in Bloom’s Taxonomy.
4. Degree – indicates how well you want the behavior to be performed or how you will evaluate learner performance.

Once you have written all four parts, you just string them together and viola – you have written a learning objective.

To help you get started, watch this brief video:

Here are some additional resources to help you select your behavior verb:

Writing Objectives Using Bloom’s Taxonomy

Writing Clear Learning Objectives

An especially useful approach to teaching when time is very short is the “One Minute Preceptor Method” described by Neher, Gordon, Meyer, and Stevens (1992) and evaluated for effectiveness in several studies. This strategy requires the preceptor to get a commitment from the learner about what the learner thinks is going on after seeing a particular patient. The preceptor then challenges the learner to provide supporting evidence for the assessment. This enables the learner to draw from previous clinical experiences, as well as coursework and readings. The preceptor gives immediate feedback to the learner about what was correct about the assessment and helps the learner recognize some general rules that applied in the specific situation.

The Process

Step #1: Get a commitment.Early into an encounter, the learner should be encouraged to make a commitment to a diagnosis, work-up, or therapeutic plan. This step is necessary for you to learn what he/she is thinking about the case. This step is also beneficial to the learner—in addition to beginning the problem-solving process, this approach will also enable the learner to feel responsible for patient care and enjoy a more collaborative role in problem solving. As the teacher you should be aware that establishing a supportive learning environment is critical to this step of the instructional method.

Step #2: Probe for Supporting Evidence.At this time, you will ask the learner to supply you with the rationale as to why he/she made the commitment previously identified. This approach fosters critical thinking and clinical reasoning skills. In addition, it will assist you, the teacher, with understanding what the learner does and does not know. Remember—this is not a grilling session. “Thinking out loud” must be a low-risk exercise.

Step #3: Teach General Rules.This is your opportunity to pull out the key message from the patient encounter. During this step, keep information to general concepts or principles, avoiding lengthy discussions or anecdotes. For example, if you have just seen a patient with hypertension disease you may choose to limit your discussion to the diagnostic work-up. Teach around knowledge gaps.

Step #4: Reinforce what was done right.Your learner may or may not know what aspect of his/her reasoning/management plan/diagnostic strategy/presentation style was effective. Make sure to let the learner know what was correct and effective.  Focus on specific skills or behaviors, not just general praise.

Step #5: Correct mistakes and identify next learning steps.If the learner has made a mistake or needs improvement, it is crucial to his/her learning that you address it. You might want to let the learner critique him/herself first then offer your specific observations and ideas for improvement. Be sure to focus on how to correct the problem or avoid it in the future. It is helpful to offer specific resources for future self-directed learning.

To summarize the One-Minute Preceptor Technique, please watch this brief video from the AACOM video library:

Interested in more? Try reviewing these references:
One-Minute Preceptor: In-Depth Description (PDF)

Microskills: One-Minute Preceptor (http://wp.vcu.edu/iteach/portfolio-items/microskills-one-minute-preceptor/)

One-Minute Preceptor Pocket Resource (PDF)