it is important to recognize what kind of work-based assessment tools have been suggested and implemented in the world of medical education in the current state.
work-based assessment tools
Mini-Clinical Evaluation Exercise (mini-CEX)
- students engage in authentic workplace-based (inpatient, outpatient, emergency department etc) patient encounters, while being observed by faculty members
- clinical tasks are carried out by the students, such as taking a focused history, carrying out relevant physical examination, after which they are required to provide a summary of the encounter followed by suggestion of next steps (e.g. working diagnosis, management plan, further investigations)
- verbal feedback is given from the assessor to the students
Clinical Encounter Cards (CEC)
- similar to Mini-CEX but with more structured set of assessment components
- these components include;
- History taking
- physical examination
- professional behavior
- technical skill
- case presentation
- problem formulation (diagnosis)
- problem solving (management)
Direct Observation of Procedural Skills (DOPS)
- more focused on the procedural skills evaluation in the workplace setting
- emphasis is given to the specific and technical feedbacks given based on the direct observations, so as to improve the students' clinical skills.
Case-based discussion (CbD)
- discussion based on the patient case records
- focuses more of the clinical reasoning and problem solving skills of the student as the assessor ask detailed questions about the rationale behind decisions made in the authentic clinical practice.
Multi-source feedback/360 degree assessment
- a systematic collection of performance data and feedback for an individual student, using multiple sources (such as peers, ward nurses, patients, faculty member)
- focuses more on the routine behavior rather than the performance and action during specific patient encounters.
Clinical Work Sampling (CWS)
- also considered a direct observation type assessment
- components being tested are:
- communication skills
- Physical examination skills
- diagnostic acumen
- consultation skills
- management skills
- interpersonal behavior
- continued learning skills
- health advocacy skills
Portfolio assessments
- collection of the students' learning records including but not limited to actual patient encounters, patient case records, student formulated action plan and student reflection and learning.
- portfolio can then be used as tools of feedback and assessment.
Characteristics of good assessment tools
- work-based assessment was created in hopes of providing a more authentic type of assessment that provides an opportunity for more relevant feedback. hence a good work-based assessment should be;
- authentic - using real case scenarios and patients
- an opportunity for giving narrative feedback
- "assessment drives learning"- work-based assessment promotes intrinsic motivation more so than other assessments because of the high fidelity of the assessment - it isn't hard to believe that if a student scores well on work-based assessments with positive feedback, s/he is on a way to be a good doctor. Hence it should be a driving factor of intrinsic motivation
- appropriate level of planning and implementation, as well as continued improvements by faculty member
- provide appropriate kind of patient (content validity), amount of patient encounters (good representation of actual patient demographics) to ensure high validity and reliability
- provide multiple different assessment modalities testing various components of student actions, skills and competence - different assessment tools have different strengths and weaknesses.
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