“The control of the licensing power is the most important function of the medical boards. Acting on behalf of the state, it is their duty to see that all candidates for license are properly qualified. They stand as guardians of the public and the profession, and here their responsibilities are indeed great.”
Osler’s statement at the Canadian Medical Association annual meeting in 1885 is still valid.
Assessment is an integral part of medical education. The primary aim of assessment is to evaluate an individual’s competence in a particular area of practise. Is this the only aim of assessment? Mackintosh and Hale (1976) suggest six possible purposes of assessment, which are: diagnosis, evaluation, grading, guidance, selection and prediction. Assessment in medical education can be formative or summative. Formative assessment helps students to develop skills and encourages learning. It is supportive and provides feedback which in turn facilitates deeper learning. The disadvantage of formative assessment is that not all students take it seriously. The summative assessment is used to judge whether an individual is competent enough to progress to the next level. It can be threatening and usually there is no feedback, however, students tend to take this form of assessment more seriously. It stimulates last minute superficial learning as opposed to the deeper learning that occurs with formative assessment. There is no single assessment tool that can reliably assess medical students. Different methods are available to assess their knowledge, skills, attitudes and professionalism. As part of this assignment I have designed two OSCE questions, which I have attached as an appendix. I will reflect on assessment methods with particular reference to the OSCE questions that I have designed.
Miller (1990) proposes a pyramidal framework for clinical assessment. The base of this pyramid represents a knowledge component (knows) followed by application of knowledge (knows how). This is in turn followed by performance (shows how) and the apex of the pyramid represents actions (does). Medical students are tested on their knowledge, application of knowledge and in vitro performance whereas work based assessment, which assesses in vivo performance, occurs after graduation and forms the final step. As a medical student my knowledge and application of knowledge was tested by written essays. Unfortunately assessment using this method is subjective. Objective approaches to test knowledge and its application include multiple-choice questions (MCQs) and extended matching questions (EMQs). Oral examinations (also known as viva voce) and long case clinical examinations were used to assess my clinical skills. Assessments of this nature are often criticised because they are unstructured and subjective. At present objective structured clinical examinations (OSCEs) form the backbone of performance assessment in medical schools throughout the United Kingdom and many other countries throughout the world.
Harden et al (1979) describe the use of Objective Structured Clinical Examination (OSCE). OSCE has changed the assessment of clinical competence because it uses actors and scenarios. In OSCE the clinical competence is assessed in a planned and structured way with attention given to the objectivity of the examination. It is a ‘focused’ examination with each station focusing on one or two areas of competence. This is a performance assessment in that it assesses student’s performance rather than their knowledge. Unlike the traditional clinical examination the objectivity of OSCE is ensured by candidates being examined by more than eight examiners, agreeing assessment criteria in advance, confronting all students with the same task, standardising patients and training examiners. The emphasis is in testing what they can do rather than what they know.