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Assess learning and provide feedback

Selecting Assessment Methods

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.

Assessing Knowledge, Skills and Attitudes

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.

More on the different domains of learning

Cognitive Domain

The cognitive domain has to do with knowledge and understanding. Students can evidence different levels of learning/achievement in this domain. Remembering (factual recall) is considered to the lowest level of learning. The ability to create new knowledge is considered to be the highest level of learning in this domain.

Table reproduced from the University of New South Wales 


Reorganise elements into a new pattern, structure or purpose (generate, plan produce, forecast, develop, invent, improve, prepare)


Come to a conclusion about something based on standards or criteria (checking, critiquing, judging, conclude, appraise, prioritise, evaluate)


Subdivide content into meaningful parts and relate the parts (differentiating, organising, attributing, inspect, categorise, contrast)


Use procedures to solve problems or complete tasks (execute, implement, translate, calculate, solve, demonstrate, adapt, practice, construct)


Construct new meaning by mixing new material with existing ideas (interpret, exemplify, classify, summarise, infer, compare, explain, paraphrase)


Retrieve pertinent facts from long-term memory (recognise, recall, describe, list, name, identify)



Psychomotor Domain

Much of the assessment of clinically based students or trainees occurs in the clinical setting - workplace based assessment - with judgements based on observation of performance in an effort to determine what a student can do. Dave's taxonomy for the psychomotor domain can be useful in determining the level of learning to be evidenced for psychomotor skills.

Table Reproduced from All Nurses Dot Com 
NaturalisationPerforming the skill automatically with ease, on a consistently high level
PrecisionCoordinating a series of actions, achieving harmony and internal consistency.


Refining, becoming more exact. Few errors are apparent.


Being able to perform certain actions by following instructions and practicing. 


Observing and return demonstrating (under close supervision of instructor) Performance may be of low quality. 


Miller's Triangle is another useful concept to determine the type of assessments required in the assessment of competence. The triangle represents the different levels of learning that might be demonstrated by students. Notice, however, that the triangle does not specify a range of abilities within "knowing how". This is where the levels of learning in the psychomotor domain are useful.


Miller, G. E. (1990). The assessment of clinical skills/competence/performance. Academic Medicine, 65(9), S63-67. 

Affective Domain

Finally, we might engage students in instruction to change their attitudes. Engaging in this sort of instruction will raise a lot of questions about the sorts of attitudes that we want our students to have and about ethical considerations when teaching to change an attitude. We are not going to deal with those issues here. We are just suggesting that if the aim of instruction is attitudinal change then  there needs to be a way to assess the change. 

Internalise or characterise values

Adopt a belief system or philosophy.

Organise or conceptualise value

Reconcile internal conflicts and develop value system.


Attach values & express personal opinions.


React and actively participate.


Open to experience, willing to hear.

Assessing Reflection

Assessing reflection can seem challenging at first, since a significant component of reflection appears to be in the affective (“feelings”) domain. But reflective practice means bringing in an intellectual understanding (cognitive domain) of how we feel or experience what we do (psychomotor domain). Thus the assessment is focused on the quality of the analysis. By understanding practice we improve it.

Important strategies include teaching and expecting students to:

  1. Link to relevant professional standards.
  2. Focus on specific elements of reflection of particular tasks or interactions—avoid generic reflection.
  3. Reference appropriate literature
  4. Develop assessments that are criterion-based (rather than norms-based) assessment
  5. Think and evaluate critically so that superficial engagement does not pass
  6. Engage and interact with their peers, their instructors and the course content in the reflection process. 

Criteria should include:

  • Substantive engagement with the topic/element (rather than superficial or wholly descriptive)
  • Linkage to relevant literature made explicitly in the reflection
  • Iterative processes, where an instructor persistently and substantively engages with learners at points of reflection and points of synthesis.

Colleague's view

Fiona Kelly talks about using a peer assessment tool with her students

Wayne Hazel talks about assessment in the clinical setting

Portfolio Possibilities

Assessment: Theory to Practice


  • Is my teaching practice based on relevant and up-to-date theories of assessment?
  • Do I understand the difference between formative and summative assessment, and use these methods appropriately in my teaching?
  • Do my assessment methods test an appropriate level of learning (as specified in learning outcomes)? 

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