Education, learning and assessment: current trends and best practice for medical educators

Abstract

Methods of teaching and assessment in medical schools have transformed over the recent past. Accreditation of medical schools through national licensing bodies and removal of bias at examinations is the norm. This review is intended to inform senior doctors who are peripherally involved in training at speciality or general professional level. From the summative assessment of learning, the uses of assessment for learning and formative assessment have transformed the process of education. Student feedback has moved centre stage. The criteria used to rate questions and abilities are made explicit and there is accountability for student and examiner performances. Standard setting for medical professional examinations is formalised through norm or criteria referencing. Objective methods to determine the pass/fail border including Angoff, Ebel, Nedelsky, Bookmark, Hofstee, borderline group and contrast by group are described. There is some evidence for grade inflation over time at universities. Blueprinting by setting test questions to learning objectives is now standard. The Objective Structured Clinical Examination uses a wide variety of case tasks at different stations. Miller's pyramid is the road map for professional competence indication where 'doing' becomes the benchmark standard. Item response theory and computer adaptive testing are available through the Concerto testing platform which is an open resource. Examining the performance of examiners as well as that of students is a necessary part of good examination practice. The World Federation for Medical Education with the World Health Organisation has developed nine standards with two categories of basic and quality for the accreditation of medical education.