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In the Ottawa 2018 Consensus framework for good assessment, a set of criteria was presented for systems of assessment. Currently, programmatic assessment is being established in an increasing number of programmes. In this Ottawa 2020 consensus statement for programmatic assessment insights from practice and research are used to define the principles of programmatic assessment. For fifteen programmes in health professions education affiliated with members of an expert group (n = 20), an inventory was completed for the perceived components, rationale, and importance of a programmatic assessment design. Input from attendees of a programmatic assessment workshop and symposium at the 2020 Ottawa conference was included. The outcome is discussed in concurrence with current theory and research. Twelve principles are presented that are considered as important and recognisable facets of programmatic assessment. Overall these principles were used in the curriculum and assessment design, albeit with a range of approaches and rigor, suggesting that programmatic assessment is an achievable education and assessment model, embedded both in practice and research. Knowledge on and sharing how programmatic assessment is being operationalized may help support educators charting their own implementation journey of programmatic assessment in their respective programmes. [ABSTRACT FROM AUTHOR]

Objective: To compare postpartum hemorrhage (PPH) patient outcomes before and after an in situ instructional design based PPH simulation attended by obstetrics and gynecology (OBGYN) residents.Methods: This uncontrolled before-and-after study was conducted in Recife, Brazil including all 1388 women delivering from June to August 2012 and all 1357 delivering from June to August 2013. The 36 OBGYN residents were divided into13 teams of two or three participants and were trained through ID based PPH simulation training with the following eight steps: (1) prior knowledge activation, (2) video demonstration, (3) dual-coding PPH protocol discussion-an image association during the training, (4) training scenario # 1, (5) debriefing, (6) training scenario # 2 with immediate feedback, (7) training scenario # 3, and (8) debriefing with self-assessment. The training scenarios had an increasing level of complexity. The main goal of the training was the adequate management of PPH and situational awareness improvement-the ability to anticipate, recognize, and intercept unfolding error chains. The primary patient outcomes rates used for the before and after comparison were therapeutic uterotonics use within 24 h of birth and blood transfusion. Secondary outcomes were therapeutic oxytocin mean dosage IU within 24 h of birth, postpartum Hb < 6 g/dL, among others. Chi-square test was used for categorical variables comparison and independent t-test for continuous variables.Results: PPH rates were 100 (7.2% of 2012 deliveries) and 80 cases (5.9% of 2013 deliveries), respectively. Comparison of primary post- and pre-simulation outcomes revealed no significant differences. However, in the comparison for therapeutic oxytocin mean dosage IU within 24 h of birth, there was an increase found after the simulation (15.98 ± 7.4 versus 25.1 ± 12.3; p < .001). For all other outcome measures, there were no statistical differences.Conclusions:In situ ID based PPH simulation leads to an increase in the mean dosage of oxytocin after training, in selected cases. This may indicate better situational awareness when managing women with PPH. [ABSTRACT FROM AUTHOR]

This AMEE guide provides a framework and practical strategies for teachers, learners and institutions to promote meaningful feedback conversations that emphasise performance improvement and professional growth. Recommended strategies are based on recent feedback research and literature, which emphasise the sociocultural nature of these complex interactions. We use key concepts from three theories as the underpinnings of the recommended strategies: sociocultural, politeness and self-determination theories. We view the content and impact of feedback conversations through the perspective of learners, teachers and institutions, always focussing on learner growth. The guide emphasises the role of teachers in forming educational alliances with their learners, setting a safe learning climate, fostering self-awareness about their performance, engaging with learners in informed self-assessment and reflection, and co-creating the learning environment and learning opportunities with their learners. We highlight the role of institutions in enhancing the feedback culture by encouraging a growth mind-set and a learning goal-orientation. Practical advice is provided on techniques and strategies that can be used and applied by learners, teachers and institutions to effectively foster all these elements. Finally, we highlight throughout the critical importance of congruence between the three levels of culture: unwritten values, espoused values and day to day behaviours. [ABSTRACT FROM AUTHOR]

Purpose: According to the principles of programmatic assessment, a valid high-stakes assessment of the students' performance should amongst others, be based on a multiple data points, supposedly leading to saturation of information. Saturation of information is generated when a data point does not add important information to the assessor. In establishing saturation of information, institutions often set minimum requirements for the number of assessment data points to be included in the portfolio. Methods: In this study, we aimed to provide validity evidence for saturation of information by investigating the relationship between the number of data points exceeding the minimum requirements in a portfolio and the consensus between two independent assessors. Data were analyzed using a multiple logistic regression model. Results: The results showed no relation between the number of data points and the consensus. This suggests that either the consensus is predicted by other factors only, or, more likely, that assessors already reached saturation of information. This study took the first step in investigating saturation of information, further research is necessary to gain in-depth insights of this matter in relation to the complex process of decision-making. [ABSTRACT FROM AUTHOR]

Feedback in medical education has traditionally showcased techniques and skills of giving feedback, and models used in staff development have focused on feedback providers (teachers) not receivers (learners). More recent definitions have questioned this approach, arguing that the impact of feedback lies in learner acceptance and assimilation of feedback with improvement in practice and professional growth. Over the last decade, research findings have emphasized that feedback conversations are complex interpersonal interactions influenced by a multitude of sociocultural factors. However, feedback culture is a concept that is challenging to define, thus strategies to enhance culture are difficult to pin down. In this twelve tips paper, we have attempted to define elements that constitute a feedback culture from four different perspectives and describe distinct strategies that can be used to foster a learning culture with a growth mind-set. [ABSTRACT FROM AUTHOR]

In medical education, students are increasingly regarded as active seekers of feedback rather than passive recipients. Previous research showed that in the intentions of students to seek feedback, a learning and performance goal can be distinguished. In this study, we investigated the intentions (defined as level and orientation of motivation) of different performing students (low, average, and high performing students) to seek feedback in the clinical workplace using Self-Determination Theory. We conducted a quantitative study with students in their clinical clerkships and grouped them based on their performance. The level of motivation was measured by the number of Mini-CEXs each student collected. The orientation of motivation was measured by conducting the Academic Self-Regulation Questionnaire. We found that high performing students were more motivated and demonstrated higher self-determination compared to low performing students. [ABSTRACT FROM AUTHOR]

Background:It remains unclear which item format would best suit the assessment of clinical reasoning: context-rich single best answer questions (crSBAs) or key-feature problems (KFPs). This study compared KFPs and crSBAs with respect to students’ acceptance, their educational impact, and psychometric characteristics when used in a summative end-of-clinical-clerkship pediatric exam. Methods:Fifth-year medical students (n = 377) took a computer-based exam that included 6–9 KFPs and 9–20 crSBAs which assessed their clinical reasoning skills, in addition to an objective structured clinical exam (OSCE) that assessed their clinical skills. Each KFP consisted of a case vignette and three key features using a “long-menu” question format. We explored students’ perceptions of the KFPs and crSBAs in eight focus groups and analyzed statistical data of 11 exams. Results:Compared to crSBAs, KFPs were perceived as more realistic and difficult, providing a greater stimulus for the intense study of clinical reasoning, and were generally well accepted. The statistical analysis revealed no difference in difficulty, but KFPs resulted more reliable and efficient than crSBAs. The correlation between the two formats was high, while KFPs correlated more closely with the OSCE score. Conclusions:KFPs with long-menu exams seem to bring about a positive educational effect without psychometric drawbacks. [ABSTRACT FROM PUBLISHER]

Context: Narrative feedback documented in performance evaluations by the teacher, i.e. the clinical supervisor, is generally accepted to be essential for workplace learning. Many studies have examined factors of influence on the usage of mini-clinical evaluation exercise (mini-CEX) instruments and provision of feedback, but little is known about how these factors influence teachers’ feedback-giving behaviour. In this study, we investigated teachers’ use of mini-CEX in performance evaluations to provide narrative feedback in undergraduate clinical training. Methods: We designed an exploratory qualitative study using an interpretive approach. Focusing on the usage of mini-CEX instruments in clinical training, we conducted semi-structured interviews to explore teachers’ perceptions. Between February and June 2013, we conducted interviews with 14 clinicians participated as teachers during undergraduate clinical clerkships. Informed by concepts from the literature, we coded interview transcripts and iteratively reduced and displayed data using template analysis. Results: We identified three main themes of interrelated factors that influenced teachers’ practice with regard to mini-CEX instruments: teacher-related factors; teacher–student interaction-related factors, and teacher–context interaction-related factors. Four issues (direct observation, relationship between teacher and student, verbal versus written feedback, formative versus summative purposes) that are pertinent to workplace-based performance evaluations were presented to clarify how different factors interact with each other and influence teachers’ feedback-giving behaviour. Embedding performance observation in clinical practice and establishing trustworthy teacher–student relationships in more longitudinal clinical clerkships were considered important in creating a learning environment that supports and facilitates the feedback exchange. Conclusion: Teachers’ feedback-giving behaviour within the clinical context results from the interaction between personal, interpersonal and contextual factors. Increasing insight into how teachers use mini-CEX instruments in daily practice may offer strategies for creating a professional learning culture in which feedback giving and seeking would be enhanced. [ABSTRACT FROM PUBLISHER]

Background: Evidence tailored to sub-Saharan Africa on outcomes of innovations in medical education is needed to encourage and advance their implementation in this region. Aim: To investigate preparedness for practice of students and graduates from an innovative and a conventional medical curriculum in a sub-Saharan African context. Methods: Using mixed methods we compared junior doctors and fifth-year students from two Mozambican medical schools: one with an innovative problem- and community-based curriculum and one with a conventional lecture- and discipline-based curriculum. A questionnaire on professional competencies was administered, semi-structured interviews were conducted, and work diaries were collected. The findings were integrated in a conceptual model. Results: Six areas of tension between global health care ideals and local health care practice emerged from the data that challenged doctors' motivation and preparedness for practice. Four elements of the innovative curriculum equipped students and graduates with skills, attitudes and competencies to better cope with these tensions. Students and graduates from the innovative curriculum rated significantly higher levels on various competencies and expressed more satisfaction with the curriculum and its usefulness for their work. Conclusion: An innovative problem- and community-based curriculum can improve sub-Saharan African doctors' motivation and preparedness to tackle the challenges of health care practice in this region. [ABSTRACT FROM AUTHOR]

Contrary to classical problem-based learning, in guided problem-based learning, the learning goals are predetermined by the instructor—on the basis of a detailed decomposition of the subject matter to be studied—to activate prior knowledge and to structure self-study and subsequent group discussion. This study investigated the effects of classical problem-based learning and guided problem-based learning, for different prior knowledge levels, on perceived value and usefulness of the learning activity and on conceptual understanding of statistics. Participants randomly assigned 110 students to 10 problem-based learning groups, and subsequently, the 10 groups were allocated randomly to classical problem-based learning or guided problem-based learning. The results indicate that guided problem-based learning tends to enhance conceptual understanding of statistics more thanbreak; classical problem-based learning once students have some prior knowledge of the subject. Furthermore, guided problem-based learning tends to increase students’ awareness of the value and usefulness of the learning activity. [ABSTRACT FROM PUBLISHER]

Background: Consistent identification and prevention of failure for at-risk medical students is challenging, failing courses is costly to all stakeholders, and there is need for further research into duration, timing and structure of interventions to help students in difficulty. Aims: To verify the value of a new exam two weeks into medical school as a predictor of failure, and explore the requirements for a preventative intervention. Methods: Students who failed the two-week exam were invited to a series of large-group workshops and small-group follow-up meetings. Participants' subsequent exam performance was compared with non-participants. Results: About 71% of students who performed poorly in the new exam subsequently failed a course. Attendance at the workshops made no difference to short- or long-term pass rates. Attendance at more than three follow-up small group sessions significantly improved pass rates two semesters later, and was influenced by teacher experience. Conclusions: Close similarity between predictor task and target task is important for accurate prediction of failure. Consideration should be given to dose effect and class size in the prevention of failure of at-risk students, and we recommend a systemic approach to intervention/remediation programmes, involving a whole semester of mandatory, weekly small group meetings with experienced teachers. [ABSTRACT FROM AUTHOR]

Context: E-learning resources, such as virtual patients (VPs), can be more effective when they are integrated in the curriculum. To gain insights that can inform guidelines for the curricular integration of VPs, we explored students' perceptions of scenarios with integrated and non-integrated VPs aimed at promoting clinical reasoning skills. Methods: During their paediatric clerkship, 116 fifth-year medical students were given at least ten VPs embedded in eight integrated scenarios and as non-integrated add-ons. The scenarios differed in the sequencing and alignment of VPs and related educational activities, tutor involvement, number of VPs, relevance to assessment and involvement of real patients. We sought students' perceptions on the VP scenarios in focus group interviews with eight groups of 4-7 randomly selected students ( n = 39). The interviews were recorded, transcribed and analysed qualitatively. Results: The analysis resulted in six themes reflecting students' perceptions of important features for effective curricular integration of VPs: (i) continuous and stable online access, (ii) increasing complexity, adapted to students' knowledge, (iii) VP-related workload offset by elimination of other activities, (iv) optimal sequencing (e.g.: lecture - 1 to 2 VP(s) - tutor-led small group discussion - real patient) and (V) optimal alignment of VPs and educational activities, (vi) inclusion of VP topics in assessment. Conclusions: The themes appear to offer starting points for the development of a framework to guide the curricular integration of VPs. Their impact needs to be confirmed by studies using quantitative controlled designs. [ABSTRACT FROM AUTHOR]

Background: Despite acknowledgement that the Canadian Medical Educational Directives for Specialists (CanMEDS) framework covers the relevant competencies of physicians, many educators and medical professionals struggle to translate the CanMEDS roles into comprehensive training programmes for specific specialties. Aim: To gain insight into the applicability of the CanMEDS framework to guide the design of educational programmes for specific specialties by exploring stakeholders' perceptions of specialty specific competencies and examining differences between those competencies and the CanMEDS framework. Methods: This case study is a sequel to a study among ObsGyn specialists. It explores the perspectives of patients, midwives, nurses, general practitioners, and hospital boards on gynaecological competencies and compares these with the CanMEDS framework. Results: Clinical expertise, reflective practice, collaboration, a holistic view, and involvement in practice management were perceived to be important competencies for gynaecological practice. Although all the competencies were covered by the CanMEDS framework, there were some mismatches between stakeholders' perceptions of the importance of some competencies and their position in the framework. Conclusion: The CanMEDS framework appears to offer relevant building blocks for specialty specific postgraduate training, which should be combined with the results of an exploration of specialty specific competencies to arrive at a postgraduate curriculum that is in alignment with professional practice. [ABSTRACT FROM AUTHOR]

Background: Conceptions of medical teachers regarding learning and teaching affect their teaching practice. Therefore conceptions should be addressed in faculty development. Aim: To facilitate this, we constructed the Conceptions Of Learning and Teaching (COLT) instrument. Method: The COLT was adapted based on experts' comments during a meeting and interviews, followed by a Delphi procedure (Part I). It was administered to teachers from two Dutch medical schools with different traditions in student-centred education (Part II; N = 646). The data were analyzed using confirmatory factor analysis and reliability analysis. Results: 324 Teachers (50.2%) completed the questionnaire. Confirmatory factor analysis did not confirm the underlying theoretical model, but an alternative model demonstrated a good fit. This led to an instrument with eighteen items reflecting three underlying factors: 'teacher centredness', 'appreciation of active learning', and 'orientation to professional practice'. We found significant differences in COLT scores between the faculty of the two medical schools. Conclusions: The COLT appears to be a construct valid tool resulting in reliable scores of teachers' conceptions of learning and teaching, in student-centred medical education. Two of the three factors are new and may be specific for student-centred medical education. The COLT may be a promising tool to improve faculty development. [ABSTRACT FROM AUTHOR]

The differences of learning experiences in the workplace put challenges on the assessment: the assessment programme should be aligned with the general competency framework of the curriculum and also fit to the differences in learning contexts of the workplace. We used van der Vleuten's programmatic assessment model to develop a workplace-based assessment programme for final year clerkships. We aimed to design a programme that stimulates learning, supports assessment decision, is feasible and non-bureaucratic. The first experiences with the programme show that students think that the programme has high learning value and the assessment is sufficiently robust. Many of the commonly reported weaknesses of work-based assessment (not a good fit with the educational context, too complex, too bureaucratic and too much work) were not mentioned by the students. [ABSTRACT FROM AUTHOR]

Background: Self-assessment is recognized as a necessary skill for lifelong learning. It is widely reported to offer numerous advantages to the learner. The research evaluated the impact of students' and supervisors' self-assessment and feedback training on students' perceptions and practices of self-assessment. Moreover, it evaluated the effect of self-assessment process on students' study strategies within a community of clinical practice. Methods: We conducted a qualitative phenomenological study from May 2008 to December 2009.We held 37 semi-structured individual interviews with three different cohorts of undergraduate medical students until we reached data saturation. The cohorts were exposed to different contexts while experiencing their clinical years' assessment program. In the interviews, students' perceptions and interpretations of 'self-assessment practice' and 'supervisor-provided feedback' within different contexts and the resulting study strategies were explored. Results: The analysis of interview data with the three cohorts of students yielded three major themes: strategic practice of self-assessment, self-assessment and study strategies, and feedback and study strategies. It appears that self-assessment is not appropriate within a summative context, and its implementation requires cultural preparation. Despite education and orientation on the two major components of the self-assessment process, feedback was more effective in enhancing deeper study strategies. Conclusion: This research suggests that the theoretical advantages linked to the self-assessment process are a result of its feedback component rather than the practice of self-assessment isolated from feedback. Further research exploring the effects of different contextual and personal factors on students' self-assessment is needed. [ABSTRACT FROM AUTHOR]

There are no scientific theories that are uniquely related to assessment in medical education. There are many theories in adjacent fields, however, that can be informative for assessment in medical education, and in the recent decades they have proven their value. In this AMEE Guide we discuss theories on expertise development and psychometric theories, and the relatively young and emerging framework of assessment for learning. Expertise theories highlight the multistage processes involved. The transition from novice to expert is characterised by an increase in the aggregation of concepts from isolated facts, through semantic networks to illness scripts and instance scripts. The latter two stages enable the expert to recognise the problem quickly and form a quick and accurate representation of the problem in his/her working memory. Striking differences between experts and novices is not per se the possession of more explicit knowledge but the superior organisation of knowledge in his/her brain and pairing it with multiple real experiences, enabling not only better problem solving but also more efficient problem solving. Psychometric theories focus on the validity of the assessment - does it measure what it purports to measure and reliability - are the outcomes of the assessment reproducible. Validity is currently seen as building a train of arguments of how best observations of behaviour (answering a multiple-choice question is also a behaviour) can be translated into scores and how these can be used at the end to make inferences about the construct of interest. Reliability theories can be categorised into classical test theory, generalisability theory and item response theory. All three approaches have specific advantages and disadvantages and different areas of application. Finally in the Guide, we discuss the phenomenon of assessment for learning as opposed to assessment of learning and its implications for current and future development and research. [ABSTRACT FROM AUTHOR]

Background: Medical curricula should focus on the future of health care. Contemporary competency frameworks for curriculum design such as Canadian Medical Education Directions for Specialists (CanMEDS), ACGME and Tomorrow's Doctors share this vision by stressing generic competencies. Aim: The objective of this study was to investigate how well a contemporary competency framework fits in with clinicians'' perspectives on future health care. Methods: Using a strategic planning approach, a semi-structured open-ended questionnaire on the future of their profession was sent to 102 Dutch gynecologists. Through inductive analysis, a future perspective and its needed competencies were identified and compared to the CanMEDS framework. Results: The 62 responses showed content validity for the CanMEDS roles. Additionally, two roles were identified: advanced technology user and entrepreneur. Within the role Communicator, the focus will change through more active patient participation. The roles Collaborator and Manager are predicted to change in focus because of an increase of complex interdisciplinary teamwork and leadership roles. Conclusion: By studying the Dutch gynecologists'' perspective of the future in a strategic planning approach, two additional roles and focus areas within a contemporary competency framework were identified. The perspective of clinicians on future health care provides valuable messages on how to design future-proof curricula. [ABSTRACT FROM AUTHOR]

In assessment a considerable shift in thinking has occurred from assessment of learning to assessment for learning. This has important implications for the conceptual framework from which to approach the issue of assessment, but also with respect to the research agenda. The main conceptual changes pertain to programmes of assessment. This has led to a broadened perspective on the types of construct assessment tries to capture, the way information from various sources is collected and collated, the role of human judgement and the variety of psychometric methods to determine the quality of the assessment. Research into the quality of assessment programmes, how assessment influences learning and teaching, new psychometric models and the role of human judgement is much needed. [ABSTRACT FROM AUTHOR]

Background: Publications in a variety of journals have described the problem of medical students'' decreasing anatomical knowledge. Interestingly, the number of people making this assertion is growing, despite a lack of empirical evidence that today's medical graduates actually know less about anatomy than medical students in the past. Nevertheless, many people are claiming that students'' anatomical knowledge is impaired due to negative effects from several factors, including teaching by non-medically qualified teachers, diminished use of cadaver dissection as a teaching tool and neglect of vertical integration of anatomy teaching. Aim: To find empirical evidence for the factors claimed to have an influence on anatomical knowledge of students. Method: A literature search. Results: There is a lack of sufficient quantity and quality of information within the existing literature to support any of the claims, but the gathered literature did reveal some fascinating insights which are discussed. Conclusion: Anatomy education should be made as effective as possible, as nobody will deny that medical students cannot do without anatomical knowledge. Because of promising findings in the areas of teaching in context, vertical integration and assessment strategies, it is recommended that future research into anatomy education should focus on these factors. [ABSTRACT FROM AUTHOR]

Given the changes in society we are experiencing, the increasing focus on patient-centred care and acknowledgement that medical education including professionalism issues needs to continue not only in the residency programmes but also throughout the doctors career, is not surprising. Although most of the literature on professionalism pertains to learning and teaching professionalism issues, addressing unprofessional behaviour and related patient safety issues forms an alternative or perhaps complementary approach. This article describes the possibility of selecting applicants for a medical school based on personality characteristics, the attention to professional lapses in contemporary undergraduate training, as well as the magnitude, aetiology, surveillance and methods of dealing with reports of unprofessional behaviour in postgraduate education and CME. [ABSTRACT FROM AUTHOR]

The potential richness of the feedback for learners and teachers is one of the educational advantages of progress tests (PTs). Every test administration yields information on a student's knowledge level in each sub-domain of the test (cross-sectional information), and it adds a next point to the corresponding knowledge growth curve (longitudinal information). Traditional paper-based feedback has severe limitations and requires considerable effort from the learners to give meaning to the data. We reasoned that the PT data should be flexibly accessible in all pathways and with any available comparison data, according to the personal interest of the learner. For that purpose, a web-based tool (Progress test Feedback, the ProF system) was developed. This article presents the principles and features of the generated feedback and shows how it can be used. In addition to enhancement of the feedback, the ProF database of longitudinal PT-data also provides new opportunities for research on knowledge growth, and these are currently being explored. [ABSTRACT FROM AUTHOR]

Background: Many medical schools provide academic support programmes to aid increasing numbers of students from diverse backgrounds. There have been calls for research into successful intervention programmes, and for detailed descriptions of how they work. Aims: To explore the efficacy of a mandatory intervention programme for at-risk medical students. Method: Students who failed and then repeated first semester were required to participate in a cognitive skills programme, following a syllabus based on principles drawn from both educational experience and multi-disciplinary theory and practice. Performance of programme participants was compared to the performance of students who repeated prior to the mandatory programme. Results: Of the participants ( n = 216), 91% passed their repeat semester, compared to 58% ( n = 715) for controls ( p < 0.0001). This significant effect persisted for progression through the school for the subsequent three semesters ( p < 0.0005). Conclusion: A mandatory programme that draws on a blend of theories and research-proven techniques can make a positive difference to the outcomes for at-risk medical students. [ABSTRACT FROM AUTHOR]

Background: Teachers involved in test development usually prefer criterion-referenced standard setting methods using panels. Since expert panels are costly, standards are often set by a pre-fixed percentage of questions answered correctly or norm-referenced methods aimed at ranking examinees. Aim: To discuss the (dis)advantages of commonly used criterion and norm-referenced methods and present a new compromise method: standards based on a fixed cut-off score using the best scoring students as reference point. Methods: Historical data from 54 Maastricht (norm-referenced) and 52 Groningen (criterion-referenced) tests were used to demonstrate huge discrepancies and variability in cut-off scores and failure rates. Subsequently, the compromise model – known as Cohen's method – was applied to the Groningen tests. Results: The Maastricht norm-referenced method led to a large variation in required cut-off scores (15–46%), but a stable failure rate (about 17%). The Groningen method with a conventional, pre-fixed standard of 60% led to a large variation in failure rates (17–97%). The compromise method reduced variation in required cut-off scores as well as failure rates. Conclusion: Both the criterion and norm-referenced standards, used in practice, have disadvantages. The proposed compromise model reduces the disadvantages of both methods and is considered more acceptable. Last but not least, compared to standard setting methods using panels, this method is affordable. [ABSTRACT FROM AUTHOR]

Collaborative learning attracts attention because of its potential as a powerful learning strategy. This also holds for PBL. However, group work in PBL sometimes encounters problems and the quality of interaction is not always at the desired level. The aim of the present study was to develop and validate a questionnaire to assess the quality of learning-oriented group interactions in PBL in an uncomplicated way. The questionnaire, to be completed by students involved in PBL, contained items on three group-interaction dimensions: exploratory questions, cumulative reasoning and handling conflicts. It was validated by means of confirmatory factor analysis and regression analysis, the latter to investigate the relation between the three-dimension model and the tutorial group's productivity. The factors underlying the questionnaire were confirmed by the data in a linear structural analysis of the data. The regression analysis showed that the ‘exploratory questions’ and ‘cumulative reasoning’ factors explained together 26% of the variance of the tutorial group's productivity. This study provided evidence for the validity of the questionnaire. The instrument contains tips for students and tutors to stimulate deep processing interactions in the tutorial group. Nevertheless, it seems useful to investigate the external validity of the questionnaire [ABSTRACT FROM AUTHOR]

AbstractIt is assumed that a programmatic approach to assessment supports students’ self-regulated learning (SRL). This study investigated students’ perceptions of this assumed support. Using a multiple-case study design, this study examined students’ perceptions in two distinct study programmes. In each case, first-year students were enrolled in an assessment programme that was designed in accordance with the principles of programmatic assessment, which integrate both assessment purposes of assessment for learning (AfL) and assessment of learning (AoL). The second-year students in each case were enrolled in an assessment programme with a traditional AoL assessment approach. The findings suggest that in both cases first-year students perceived their assessment programme as more positive for their learning than second-year students. Through a cross-case analysis of students’ perceptions of the two assessment programmes, three themes were identified that are essential to support students’ SRL: 1) assessment design; 2) assessment as a dialogue; and 3) assessment as an information source. Key aspects of the themes that support or hinder SRL are discussed. The findings of this study highlight the importance of programme-level assessment design to support students in their SRL. [ABSTRACT FROM AUTHOR]

Background: Teaching and assessment of professional behaviour (PB) has been receiving increasing attention in the educational literature and educational practice. Although the focus tends to be summative aspects, it seems perfectly feasible to combine formative and summative approaches in one procedural approach. Aims and method: Although, many examples of frameworks of professionalism and PB can be found in the literature, most originate from North America, and only few are designed in other continents. This article presents the framework for PB that is used at Maastricht medical school, the Netherlands. Results: The approach to PB used in the Dutch medical schools is described with special attention to 4 years (2005-2009) of experience with PB education in the first 3 years of the 6-year undergraduate curriculum of Maastricht medical school. Future challenges are identified. Conclusions: The adages 'Assessment drives learning' and 'They do not respect what you do not inspect' [Cohen JJ. 2006. Professionalism in medical education, an American perspective: From evidence to accountability. Med Educ 40, 607-617] suggest that formative and summative aspects of PB assessment can be combined within an assessment framework. Formative and summative assessments do not represent contrasting but rather complementary approaches. The Maastricht medical school framework combines the two approaches, as two sides of the same coin. [ABSTRACT FROM AUTHOR]

Background: Clinical workplaces are hectic and dynamic learning environments, which require students to take charge of their own learning. Competency development during clinical internships is a continuous process that is facilitated and guided by feedback. Limited feedback, lack of supervision and problematic assessment of clinical competencies make the development of learning instruments to support self-directed learning necessary. Aims: To explore students’ perceptions about a newly introduced integrated feedback and assessment instrument to support self-directed learning in clinical practice. Students collected feedback from clinical supervisors and wrote it on a competency-based format. This feedback was used for self-assessment, which had to be completed before the final assessment. Methods: Four focus group discussions were conducted with second and last year Midwifery students. Focus groups were audiotaped, transcribed verbatim and analysed in a thematic way using ATLAS.ti for qualitative data analysis. Results: The analysis of the transcripts suggested that integrating feedback and assessment supports participation and active involvement in learning by collecting, writing, asking, reading and rereading feedback. Under the condition of training and dedicated time, these learning activities stimulate reflection and facilitate the development of strategies for improvement. The integration supports self-assessment and formative assessment but the value for summative assessment is contested. The quality of feedback and empowerment by motivated supervisors are essential to maximise the learning effects. Conclusions: The integrated Midwifery Assessment and Feedback Instrument is a valuable tool for supporting formative learning and assessment in clinical practice, but its effect on students’ self-directed learning depends on the feedback and support from supervisors. [ABSTRACT FROM AUTHOR]

Background: Tutorial group effectiveness is essential for the success of learning in problem-based learning (PBL). Less effective and dysfunctional groups compromise the quality of students learning in PBL. Aims: This article aims to report on the reliability and validity of an instrument aimed at measuring tutorial group effectiveness in PBL. Method: The items within the instrument are clustered around motivational and cognitive factors based on Slavin's theoretical framework. A confirmatory factor analysis (CFA) was carried out to estimate the validity of the instrument. Furthermore, generalizability studies were conducted and alpha coefficients were computed to determine the reliability and homogeneity of each factor. Results: The CFA indicated that a three-factor model comprising 19 items showed a good fit with the data. Alpha coefficients per factor were high. The findings of the generalizability studies indicated that at least 9–10 student responses are needed in order to obtain reliable data at the tutorial group level. Conclusion: The instrument validated in this study has the potential to provide faculty and students with diagnostic information and feedback about student behaviors that enhance and hinder tutorial group effectiveness. [ABSTRACT FROM AUTHOR]