Abstract
BackgroundAssessing competence of advanced undergraduate medical students based on performance in the clinical context is the ultimate, yet challenging goal for medical educators to provide constructive alignment between undergraduate medical training and professional work of physicians. Therefore, we designed and validated a performance-based 360-degree assessment for competences of advanced undergraduate medical students.MethodsThis study was conducted in three steps: 1) Ten facets of competence considered to be most important for beginning residents were determined by a ranking study with 102 internists and 100 surgeons. 2) Based on these facets of competence we developed a 360-degree assessment simulating a first day of residency. Advanced undergraduate medical students (year 5 and 6) participated in the physician’s role. Additionally knowledge was assessed by a multiple-choice test. The assessment was performed twice (t1 and t2) and included three phases: a consultation hour, a patient management phase, and a patient handover. Sixty-seven (t1) and eighty-nine (t2) undergraduate medical students participated. 3) The participants completed the Group Assessment of Performance (GAP)-test for flight school applicants to assess medical students‘ facets of competence in a non-medical context for validation purposes. We aimed to provide a validity argument for our newly designed assessment based on Messick’s six aspects of validation: (1) content validity, (2) substantive/cognitive validity, (3) structural validity, (4) generalizability, (5) external validity, and (6) consequential validity.ResultsOur assessment proved to be well operationalised to enable undergraduate medical students to show their competences in performance on the higher levels of Bloom’s taxonomy. Its generalisability was underscored by its authenticity in respect of workplace reality and its underlying facets of competence relevant for beginning residents. The moderate concordance with facets of competence of the validated GAP-test provides arguments of convergent validity for our assessment. Since five aspects of Messick’s validation approach could be defended, our competence-based 360-degree assessment format shows good arguments for its validity.ConclusionAccording to these validation arguments, our assessment instrument seems to be a good option to assess competence in advanced undergraduate medical students in a summative or formative way. Developments towards assessment of postgraduate medical trainees should be explored.
Highlights
Assessing competence of advanced undergraduate medical students based on performance in the clinical context is the ultimate, yet challenging goal for medical educators to provide constructive alignment between undergraduate medical training and professional work of physicians
Our assessment proved to be well operationalised to enable undergraduate medical students to show their competences in performance on the higher levels of Bloom’s taxonomy
Its generalisability was underscored by its authenticity in respect of workplace reality and its underlying facets of competence relevant for beginning residents
Summary
Assessing competence of advanced undergraduate medical students based on performance in the clinical context is the ultimate, yet challenging goal for medical educators to provide constructive alignment between undergraduate medical training and professional work of physicians. Since competences are abstract and not directly measurable, workplace-based assessments like Mini-CEX and DOPS ease the evaluation of candidates’ competences while observing their performance of professional activities Such assessment formats take place in the real work situation, they are lacking standardization and cannot be used with larger numbers of participants at the same time [12]. The simulation of a first working day in the clinical environment, during which students show their competences by performance, seems to be an adequate and valid format to test competences needed for a successful transition from undergraduate to postgraduate medical training. Such a performance-based assessment model was established in 2011 in the Netherlands and Germany [13]
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