Assess learning and provide feedback

Assessments can be either formative (how am I doing?) or summative  (how did I do?).

• Formative assessment guides further learning, so it includes feedback on areas of strength and weakness. Formative assessment provides information on how learning is proceeding so it can be useful both to improve individual student learning and to improve teaching.
• Summative assessment usually occurs at the end of a course, and the results are used to grade students and determine whether they have achieved competencies and standards.

Before choosing methods, ask yourself the following questions:

• What is the purpose of the assessment?
• Does my chosen assessment align with the intended learning outcomes?
• How will I provide feedback on the assessment to students?

Choosing appropriate methods is important because different methods measure different types of learning.  Multiple choice questions, for instance, are useful for assessing factual recall and sometimes problem-solving.  When written well, they have the advantage of high reliability and are easy to mark.  However, MCQs can cue students to the correct response, and for this reason, other methods might be preferred.

Other assessment methods include: essays; short-answer questions; multiple choice questions; multiple-choice (single best answer and extended matching); self-assessment/ peer assessment; learning portfolios; case studies and projects; structured oral vivas; structured objective practical assessments e.g. OSCE; direct observation of professional, technical or clinical practice; case/record review. 

Direct observation of practice should form the basis of judgements of workplace performance. A range of structured workplace assessment tools have been developed in an attempt to make this form of assessment reliable. Widely used methods include the mini clinical evaluation exercise (mini-CEX), direct observation of procedural skills (DOPS), objective stuctured assessment of technical skills (OSATS), competency assessment, and multi-source feedback.

Assessment is often focused on testing knowledge. However, there is more to being a competent health professional or scientist than having sound theoretical knowledge. Students and trainees must also demonstrate that they can apply their knowledge, ultimately being able to perform appropriately without supervision in the workplace.  At the same time, however, it is ability that is the most difficult to measure.  Assessments that primarily test knowledge (e.g. examinations) are of limited value in predicting what a graduate will do when they enter the workforce. Students will also have to work with patients in a variety of settings. It may, therefore, be appropriate to teach students about appropriate attitudes and to assess students in this area.

Students may, therefore, be assessed on:

• what they know (cognitive domain)
• skills they have learned (psychomotor domain)
• attitudes that they have been taught (affective domain).

It is important to assess students at the appropriate level. For example, if the learning outcomes for a course specify that students will be able to recall basic facts then the assessment must test their ability to recall basic facts. As a second example, if the learning outcomes for a course specify that students will be able to expertly perform a clinical skill, then the assessment must test expert ability. Knowledge of the different levels of learning in the three domains (cognitive, psychomotor and affective) can help to ensure that assessment(s) test students at the appropriate level i.e. assessment fits with levels of learning specified in the learning outcomes.

Assessing Reflection