The Next Era of Assessment: Can Ensuring High-Quality, Equitable Patient Care Be the Defining Characteristic?

Abstract

Previous eras of assessment in medical education have been defined by how assessment is done, from knowledge exams popularized in the 1960s to the emergence of work-based assessment in the 1990s to current efforts to integrate multiple types and sources of performance data through programmatic assessment. Each of these eras was a response to why assessment was performed (e.g., assessing medical knowledge with exams; assessing communication, professionalism, and systems competencies with work-based assessment). Despite the evolution of assessment eras, current evidence highlights the graduation of trainees with foundational gaps in the ability to provide high-quality care to patients presenting with common problems, and training program leaders report they graduate trainees they would not trust to care for themselves or their loved ones. In this article, the authors argue that the next era of assessment should be defined by why assessment is done: to ensure high-quality, equitable care. Assessment should place focus on demanding graduates possess the knowledge, skills, attitudes, and adaptive expertise to meet the needs of all patients and ensuring that graduates are able to do this in an equitable fashion. The authors explore 2 patient-focused assessment approaches that could help realize the promise of this envisioned era: entrustable professional activities (EPAs) and resident sensitive quality measures (RSQMs)/TRainee Attributable and Automatable Care Evaluations in Real-time (TRACERs). These examples illustrate how the envisioned next era of assessment can leverage existing and new data to provide precision education assessment that focuses on providing formative and summative feedback to trainees in a manner that seeks to ensure their learning outcomes prepare them to ensure high-quality, equitable patient outcomes.