Abstract

The recent rise of interest among the medical education community in individual faculty making subjective judgments about medical trainee performance appears to be directly related to the introduction of notions of integrated competency-based education and assessment for learning. Although it is known that assessor expertise plays an important role in performance assessment, the roles played by different factors remain to be unraveled. We therefore conducted an exploratory study with the aim of building a preliminary model to gain a better understanding of assessor expertise. Using a grounded theory approach, we conducted seventeen semi-structured interviews with individual faculty members who differed in professional background and assessment experience. The interviews focused on participants’ perceptions of how they arrived at judgments about student performance. The analysis resulted in three categories and three recurring themes within these categories: the categories assessor characteristics, assessors’ perceptions of the assessment tasks, and the assessment context, and the themes perceived challenges, coping strategies, and personal development. Central to understanding the key processes in performance assessment appear to be the dynamic interrelatedness of the different factors and the developmental nature of the processes. The results are supported by literature from the field of expertise development and in line with findings from social cognition research. The conceptual framework has implications for faculty development and the design of programs of assessment.

Highlights

  • IntroductionUndergraduate and graduate medical curricula are being reformed. Where in the past the main focus was on well-defined learning outcomes, today the notion of integrated competencies is rapidly gaining ground (ten Cate and Scheele 2007), posing new challenges to assessment

  • Around the world, undergraduate and graduate medical curricula are being reformed

  • The analysis resulted in three categories and three recurring themes within these categories: the categories assessor characteristics, assessors’ perceptions of the assessment tasks, and the assessment context, and the themes perceived challenges, coping strategies, and personal development

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Summary

Introduction

Undergraduate and graduate medical curricula are being reformed. Where in the past the main focus was on well-defined learning outcomes, today the notion of integrated competencies is rapidly gaining ground (ten Cate and Scheele 2007), posing new challenges to assessment. Rooted in the psychometric discourse, the traditional objective of assessment was to ascertain objectively whether students had attained the desired results (Hodges 2006) This type of assessment is characterized by highly standardized settings where the influence of individual assessors was minimized. Subjectivity does not necessarily imply unreliability (Van der Vleuten et al 1991; Swanson et al 1995), it is of critical importance to reduce the risk of arbitrary judgment, especially when assessment relies on single judgments by single assessors Before incorporating such assessments in a program of assessment, measures should be in place to optimize the credibility and defensibility of the assessments, which in turn should be grounded in a good understanding of human judgment in performance assessment

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