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Workplace-Based Assessment (WBA) plays a pivotal role in present-day competency-based medical curricula. Validity in WBA mainly depends on how stakeholders (e.g. clinical supervisors and learners) use the assessments--rather than on the intrinsic qualities of instruments and methods. Current research on assessment in clinical contexts seems to imply that variable behaviours during performance assessment of both assessors and learners may well reflect their respective beliefs and perspectives towards WBA. We therefore performed a Q methodological study to explore perspectives underlying stakeholders' behaviours in WBA in a postgraduate medical training program. Five different perspectives on performance assessment were extracted: Agency, Mutuality, Objectivity, Adaptivity and Accountability. These perspectives reflect both differences and similarities in stakeholder perceptions and preferences regarding the utility of WBA. In comparing and contrasting the various perspectives, we identified two key areas of disagreement, specifically "the locus of regulation of learning" (i.e., self-regulated versus externally regulated learning) and 'the extent to which assessment should be standardised' (i.e., tailored versus standardised assessment). Differing perspectives may variously affect stakeholders' acceptance, use--and, consequently, the effectiveness--of assessment programmes. Continuous interaction between all stakeholders is essential to monitor, adapt and improve assessment practices and to stimulate the development of a shared mental model. Better understanding of underlying stakeholder perspectives could be an important step in bridging the gap between psychometric and socio-constructivist approaches in WBA.

Progress testing provides data on the growth of students' knowledge over the course of the curriculum obtained from the results of all students in the curriculum on periodical similar tests pitched at end-of-curriculum level. Since 2001, three medical schools have jointly constructed and administered four progress tests annually. All students in the 6-year undergraduate curricula of these schools take the same tests resulting in 24 distinct measurements per academic year (four tests for six student year groups), which may be used to compare performance between and within schools. Because single point measurements had proven unreliable, we devised a method to use cumulative information to compare schools' test performance. This cumulative deviation method involves calculation of the deviations of schools' scores from the cross-institutional average score for 24 measurement moments in 1 year. The current study shows that it appears to be feasible to use a combination of the cumulative deviation method and trend analysis for subdomains of medical knowledge to detect strengths and weaknesses in knowledge development in medical curricula. We illustrate the method by applying it to data from 16 consecutive progress tests administered to all students (4,300) of three medical schools in the academic years 2001/2002 through 2004/2005.

Developed a method to estimate the cutscore precisions for empirical standard-setting methods by using resampling. Illustrated the method with two actual datasets consisting of 86 Dutch medical residents and 155 Canadian medical students taking objective structured clinical examinations. Results show the applicability of the method. (SLD)

Compared four standard-setting procedures for an objective structure clinical examination (OSCE) in medical education. Applied Angoff, borderline, relative, and holistic procedures to the data used to establish a cutoff score for a pass/fail decision. The Angoff and borderline procedures gave similar results; however, the relative and holistic methods gave widely divergent results. (Author/DB)

Sequential, standardized patient-based tests were given to medical students at the University of Maastricht (Netherlands); the first test was a screening test that evaluated the efficiency/validity of cutoff scores. Findings indicated that stringent pass/fail cutoff scores on the screening test produced optimal results. Fewer than 0.2 percent of students who passed the screening test failed the complete test. (DB)

Objectives: This study explores the optimal focus for negotiation skills development training by investigating how often medical residents negotiate in practice, and how they perceive the effectiveness of their negotiation capabilities. Methods: An exploratory study was performed using a questionnaire regarding the medical residents' working environment, negotiation frequency, knowledge and skills using a 5- point Likert scale, multiple choice questions and open questions. Exploratory factor analysis with principal component analysis, varimax rotation, reliability analysis, and content analysis were used to reduce the number of variables. Descriptive and interferential statistics and multiple regression analysis were used to analyze the data. Results: We analyzed the responses of 60 medical residents. The findings showed that the perceived development of their negotiation knowledge (M=3.06, SD=0.83) was less than their negotiation skills (M=3.69, SD=0.47). Their attitude during negotiations, especially females, differed substantially in the interactions with nurses than with their supervisors. Medical residents with more working experience, better negotiation skills or who worked in hierarchical environments negotiated more frequently with their supervisors. Medical residents with better collaboration skills and negotiation knowledge demonstrated better negotiation skills. Conclusions: This study underlines medical residents' need for negotiation training. In addition to the basic negotiation knowledge and skills, training programs in negotiation should focus on the medical residents' awareness of their attitudes during negotiations, combining the assertiveness shown in interactions with supervisors with the empathy and emotional engagement present in interactions with nurses. Furthermore, attention should be paid to the influence of the environmental hierarchy on negotiation skill development. [ABSTRACT FROM AUTHOR]

Workplace-Based Assessment (WBA) plays a pivotal role in present-day competency-based medical curricula. Validity in WBA mainly depends on how stakeholders (e.g. clinical supervisors and learners) use the assessments-rather than on the intrinsic qualities of instruments and methods. Current research on assessment in clinical contexts seems to imply that variable behaviours during performance assessment of both assessors and learners may well reflect their respective beliefs and perspectives towards WBA. We therefore performed a Q methodological study to explore perspectives underlying stakeholders' behaviours in WBA in a postgraduate medical training program. Five different perspectives on performance assessment were extracted: Agency, Mutuality, Objectivity, Adaptivity and Accountability. These perspectives reflect both differences and similarities in stakeholder perceptions and preferences regarding the utility of WBA. In comparing and contrasting the various perspectives, we identified two key areas of disagreement, specifically 'the locus of regulation of learning' (i.e., self-regulated versus externally regulated learning) and 'the extent to which assessment should be standardised' (i.e., tailored versus standardised assessment). Differing perspectives may variously affect stakeholders' acceptance, use-and, consequently, the effectiveness-of assessment programmes. Continuous interaction between all stakeholders is essential to monitor, adapt and improve assessment practices and to stimulate the development of a shared mental model. Better understanding of underlying stakeholder perspectives could be an important step in bridging the gap between psychometric and socio-constructivist approaches in WBA. [ABSTRACT FROM AUTHOR]

Background In 2005 a competency based curriculum was introduced in the Dutch postgraduate medical training programs. While the manager's role is one of the seven key competencies, there is still no formal management course in most postgraduate curricula. Based on a needs assessment we conducted, several themes were identified as important for a possible management training program. We present the results of the pilot training we performed to investigate two of these themes. Methods The topics "knowledge of the healthcare system" and "time management" were developed from the list of suggested management training themes. Fourteen residents participated in the training and twenty-four residents served as control. The training consisted of two sessions of four hours with a homework assignment in between. 50 True/false-questions were given as pre- and post-test to both the test and control groups to assess the level of acquired knowledge among the test group as well as the impact of the intervention. We also performed a qualitative evaluation using evaluation forms and in-depth interviews. Results All fourteen residents completed the training. Six residents in the control group were lost to follow up. The pre- and post-test showed improvement among the participating residents in comparison to the residents from the control group, but this improvement was not significant. The qualitative assessment showed that all residents evaluated the training positively and experienced it as a useful addition to their training in becoming a medical specialist. Conclusion Our training was evaluated positively and considered to be valuable. This study supports the need for mandatory medical management training as part of the postgraduate medical curriculum. Our training could be an example of how to teach two important themes in the broad area of medical management education. [ABSTRACT FROM AUTHOR]

Context One goal of undergraduate assessment is to test students’ (future) performance. In the area of skills testing, the objective structured clinical examination (OSCE) has been of great value as a tool with which to test a number of skills in a limited time, with bias reduction and improved reliability. But can OSCEs measure undergraduate internship expertise in basic clinical skills? Methods Undergraduate students ( n = 32) were given a questionnaire listing 182 basic clinical skills. We asked them to score the number of times they had performed each skill during their internships (a 12-month period in Year 6). We assessed the students at the end of Year 5 (before the start of their internships) and again at the start of Year 7 (undergraduate training takes 7 years in Belgium, with internships during Year 6), using a 14-station OSCE assessing basic clinical skills. Global ratings were used to score performance. The relationship between internship experience and the OSCE Year 7 score was analysed using a linear regression model, controlling for variation in OSCE scores from Year 5. A multi-level analysis was performed considering students as level-1 units and stations as level-2 units. Results Year 7 OSCE scores (post-internships) were not affected by the number of times that students practised basic medical skills during their internships. Discussion Scores on OSCEs do not seem to reflect clinical expertise acquired during internships. Other more integrated assessment methods may prove to be more valid for testing final undergraduate skills levels. [ABSTRACT FROM AUTHOR]

Objective To test hypotheses regarding the longitudinal effects of problem-based learning (PBL) and conventional learning relating to students’ appreciation of the curriculum, self-assessment of general competencies, summative assessment of clinical competence and indicators of career development. Methods The study group included 2 complete cohorts of graduates who were admitted to the medical curriculum in 1992 (conventional curriculum, n = 175) and 1993 (PBL curriculum, n = 169) at the Faculty of Medicine, University of Groningen, the Netherlands. Data were obtained from student records, graduates’ self-ratings and a literature search. Gender and secondary school grade point average (GPA) scores were included as moderator variables. Data were analysed by a stepwise multiple and logistic regression analysis. Results Graduates of the PBL curriculum scored higher on self-rated competencies. Contrary to expectations, graduates of the PBL curriculum did not show more appreciation of their curriculum than graduates of the conventional curriculum and no differences were found on clinical competence. Graduates of the conventional curriculum needed less time to find a postgraduate training place. No differences were found for scientific activities such as reading scientific articles and publishing in peer- reviewed journals. Women performed better on clinical competence than did men. Grade point average did not affect any of the variables. Conclusions The results suggest that PBL affects self-rated competencies. These outcomes confirm earlier findings. However, clinical competence measures did not support this finding. [ABSTRACT FROM AUTHOR]

Objective To determine the effectiveness of single-point benchmarking and longitudinal benchmarking for inter-school educational evaluation. Methods We carried out a mixed, longitudinal, cross-sectional study using data from 24 annual measurement moments (4 tests × 6 year groups) over 4 years for 4 annual progress tests assessing the graduation-level knowledge of all students from 3 co-operating medical schools. Participants included undergraduate medical students (about 5000) from 3 medical schools. The main outcome measures involved between-school comparisons of progress test results based on different benchmarking methods. Results Variations in relative school performance across different tests and year groups indicate instability and low reliability of single-point benchmarking, which is subject to distortions as a result of school-test and year group-test interaction effects. Deviations of school means from the overall mean follow an irregular, noisy pattern obscuring systematic between-school differences. The longitudinal benchmarking method results in suppression of noise and revelation of systematic differences. The pattern of a school’s cumulative deviations per year group gives a credible reflection of the relative performance of year groups. Conclusions Even with highly comparable curricula, single-point benchmarking can result in distortion of the results of comparisons. If longitudinal data are available, the information contained in a school’s cumulative deviations from the overall mean can be used. In such a case, the mean test score across schools is a useful benchmark for cross-institutional comparison. [ABSTRACT FROM AUTHOR]

Objective To determine whether items of progress tests used for inter-curriculum comparison favour students from the medical school where the items were produced (i.e. whether the origin bias of test items is a potential confounder in comparisons between curricula). Methods We investigated scores of students from different schools on subtests consisting of progress test items constructed by authors from the different schools. In a cross-institutional collaboration between 3 medical schools, progress tests are jointly constructed and simultaneously administered to all students at the 3 schools. Test score data for 6 consecutive progress tests were investigated. Participants consisted of approximately 5000 undergraduate medical students from 3 medical schools. The main outcome measure was the difference between the scores on subtests of items constructed by authors from 2 of the collaborating schools (subtest difference score). Results The subtest difference scores showed that students obtained better results on items produced at their own schools. This effect was more pronounced in Years 2–5 of the curriculum than in Year 1, and diminished in Year 6. Conclusions Progress test items were subject to origin bias. As a consequence, all participating schools should contribute equal numbers of test items if tests are to be used for valid and fair inter-curriculum comparisons. [ABSTRACT FROM AUTHOR]

Context We addressed the assessment of professional behaviour in tutorial groups by investigating students' perceptions of the frequency and impact of critical incidents that impede this assessment and 5 factors underlying these critical incidents. Methods A questionnaire asking students to rate the frequency and impact of 40 critical incidents relating to effective assessment of professional behaviour on a 5-point Likert scale was developed and sent to all undergraduate medical students in Years 2–4 of a 6-year undergraduate curriculum. Results The response rate was 70% ( n = 393). Important factors underlying critical incidents are: lack of effective interaction; lack of thoroughness; tutors' failure to confront students with unprofessional behaviour; lack of effort to find solutions, and lack of student motivation. Confirmatory factor analysis showed a good model fit. Because the relationship between frequency of occurrence and degree of impediment varies, the best information about the true impact of critical incidents and the underlying factors is provided by the product of frequency and degree of impediment. Frequency of occurrence remains stable and degree of impediment increases in Years 2–4. Conclusions The results of this study can be used to design and improve faculty development programmes aimed at improving assessment of professional behaviour. Training programmes should motivate tutors by providing background information as to why and how sound assessment of professional behaviour is to be performed and encourage tutors to confront students with and discuss all aspects of professional behaviour, as well as provide appropriate feedback. [ABSTRACT FROM AUTHOR]

In-training assessment (ITA), defined as multiple assessments of performance in the setting of day-to-day practice, is an invaluable tool in assessment programmes which aim to assess professional competence in a comprehensive and valid way. Research on clinical performance ratings, however, consistently shows weaknesses concerning accuracy, reliability and validity. Attempts to improve the psychometric characteristics of ITA focusing on standardisation and objectivity of measurement thus far result in limited improvement of ITA-practices. The aim of the paper is to demonstrate that the psychometric framework may limit more meaningful educational approaches to performance assessment, because it does not take into account key issues in the mechanics of the assessment process. Based on insights from other disciplines, we propose an approach to ITA that takes a constructivist, social-psychological perspective and integrates elements of theories of cognition, motivation and decision making. A central assumption in the proposed framework is that performance assessment is a judgment and decision making process, in which rating outcomes are influenced by interactions between individuals and the social context in which assessment occurs. The issues raised in the article and the proposed assessment framework bring forward a number of implications for current performance assessment practice. It is argued that focusing on the context of performance assessment may be more effective in improving ITA practices than focusing strictly on raters and rating instruments. Furthermore, the constructivist approach towards assessment has important implications for assessment procedures as well as the evaluation of assessment quality. Finally, it is argued that further research into performance assessment should contribute towards a better understanding of the factors that influence rating outcomes, such as rater motivation, assessment procedures and other contextual variables. [ABSTRACT FROM AUTHOR]

Background: There is a lack of explicit criteria for the assessment of students' research reports. Teachers tend to use their own, idiosyncratic sets of implicit criteria. A well-defined set of criteria could foster reliable and valid assessment of students' research reports. Aim: The aim of this study was twofold: to detect the strengths and weaknesses of students' research reports and to develop an assessment tool for students' research papers. Methods: On the basis of the literature and advice from experts, we developed a list of 19 criteria, comprising 15 specific items and 4 global items. Three raters, using the list, independently scored a sample of 18 research reports. Results: The strengths of the reports were the structure of the results and the description of materials and methods. The weaknesses were the research questions, the grounding of the study in the research literature, the analysis, the statistics, and the clarity of visuals. With three raters, the reliability of the rating scale was reasonable. Conclusion: The rating scale seems to be a useful tool for judging and giving feedback on students' research reports. These findings will have to be confirmed in studies with larger samples. [ABSTRACT FROM AUTHOR]

Context The portfolio is becoming increasingly accepted as a valuable tool for learning and assessment. The validity of portfolio assessment, however, may suffer from bias due to irrelevant qualities, such as lay-out and writing style. We examined the possible effects of such qualities in a portfolio programme aimed at stimulating Year 1 medical students to reflect on their professional and personal development. In later curricular years, this portfolio is also used to judge clinical competence. Methods We developed an instrument, the Portfolio Analysis Scoring Inventory, to examine the impact of form and content aspects on portfolio assessment. The Inventory consists of 15 items derived from interviews with experienced mentors, the literature, and the criteria for reflective competence used in the regular portfolio assessment procedure. Forty portfolios, selected from 231 portfolios for which ratings from the regular assessment procedure were available, were rated by 2 researchers, independently, using the Inventory. Regression analysis was used to estimate the correlation between the ratings from the regular assessment and those resulting from the Inventory items. Results Inter-rater agreement ranged from 0.46 to 0.87. The strongest predictor of the variance in the regular ratings was ‘quality of reflection’ (R 0.80; R2 66%). No further items accounted for a significant proportion of variance. Irrelevant items, such as writing style and lay-out, had negligible effects. Conclusions The absence of an impact of irrelevant criteria appears to support the validity of the portfolio assessment procedure. Further studies should examine the portfolio's validity for the assessment of clinical competence. [ABSTRACT FROM AUTHOR]

Objective To investigate the effects of a virtual learning environment (VLE) on group interaction and consultation of information resources during the preliminary phase, self-study phase and reporting phase of the problem-based learning process in an undergraduate medical curriculum. Methods A questionnaire was administered to 355 medical students in Years 1 and 2 to ask them about the perceived usefulness of a virtual learning environment that was created with Blackboard for group interaction and the use of learning resources. Results The students indicated that the VLE supported face-to-face interaction in the preliminary discussion and in the reporting phase but did not stimulate computer-mediated distance interaction during the self-study phase. They perceived that the use of multimedia in case presentations led to a better quality of group discussion than if case presentations were exclusively text-based. They also indicated that the information resources that were hyperlinked in the VLE stimulated the consultation of these resources during self-study, but not during the reporting phase. Conclusions Students indicated that the use of a VLE in the tutorial room and the inclusion of multimedia in case presentations supported processes of active learning in the tutorial groups. However, if we want to exploit the full potential of asynchronous computer-mediated communication to initiate in-depth discussion during the self-study phase, its application will have to be selective and deliberate. Students indicated that the links in the VLE to selected information in library repositories supported their learning. [ABSTRACT FROM AUTHOR]

Sequential testing is applied to reduce costs in SP-based tests (OSCEs). Initially, all candidates take a screening test consisting of a part of the OSCE. Candidates who fail the screen sit the complete test, whereas those who pass the screen are qualified as a pass of the complete test. The procedure may result in a reduction of testing resources, but at the cost of false positives (candidates who pass the screen but would fail the complete test). In a diagnostic test an optimum cutpoint is obtained by minimizing the weighted sum of false negatives and false positives using Receiver Operator Characteristic (ROC) analysis. However, in the sequential procedure there are no false negatives, because the result of the complete test is considered the final outcome. Several authors ignored this difference and applied classic ROC analysis to a sequential test. Earlier, we doubted the validity of the procedure and proposed to set the cutpoint by minimizing the loss, defined as the weighted sum of the screen negatives and the false positives. Recently, Regehr and Colliver (2003) argued that under certain theoretically derived conditions the use of the loss formula in sequential testing is functionally identical to using classic ROC analysis. The current study shows (a) the conclusion of Regehr and Colliver is based on assumptions that can be challenged, and (b) ROC analysis indeed can be used in sequential testing, but only if the procedure is modified according to the results of a corresponding loss function analysis. [ABSTRACT FROM AUTHOR]

Introduction: In health science education clinical clerkships serve the twofold purpose of guiding student learning and assessment of performance. Evidently, both formative and summative assessment procedures are needed in clerkship assessment. In-training evaluation (ITE) has the potential to serve both assessment functions. Implementation of effective ITE, however, has been shown to be problematic, partly because integration of assessment functions may have negative consequences for teaching and learning. This study investigates student perceptions of the impact of an integrated assessment approach, seeking to refine criteria for effective ITE. Method: In the curriculum of Maastricht Midwifery School (MMS), clerkship assessment is based on ITE serving both assessment functions. The ITE model is based on principles of extensive work sampling, and frequent documentation of performance. A focus group technique was used to explore student perceptions on the impact of the ITE approach on student learning and supervisor teaching behaviour, and on the usefulness of information for decision making. Results: Results indicate that the assessment approach is effective in guidance of student learning. Furthermore, students consider the frequent performance documentation essential in clerkship grading. Acceptance and effectivity of ITE requires a learning environment which is safe and respectful. Transparency of assessment processes is the key to success. Suggestions for improvement focus on variation in evaluation formats, improvement of feedback (narrative, complete) and student involvement in assessment. Conclusion: ITE can fulfill both its formative and summative purposes when some crucial conditions are taken into account. Careful training of both supervisors and students in the use of ITE for student learning and performance measurement is essential. [ABSTRACT FROM AUTHOR]

For more than two decades the Medical School in Maastricht, the Netherlands, has used simulated patients (SPs) to provide students with opportunities to practise their skills in communication and physical examination. In this educational setting a student meets a SP in a videotaped session. Feedback by the SP to the student at the end of the session is considered an important educational feature. We found no instruments to assess individual SP performance during those sessions. To develop a valid, reliable and feasible instrument to evaluate the performance of SPs. The content of the instrument was validated through interviews with students, teachers and experts who are involved with SPs. They were asked to indicate key features of good SP performance. Based on the interviews, a written checklist was developed to measure individual SP performance. The instrument was evaluated in a regular SP session at the medical school, involving 152 students and their teachers. All interviewees considered the scale to be satisfactory and the instrument to be valid. The feasibility and reliability of the checklists were investigated using the data of 398 returned checklists. Cronbach's alpha was found to be 0.73. Generalizability analysis showed that 12 completed checklists were required to obtain a reliable assessment of one SP. The Maastricht Assessment of Simulated Patients (MaSP) appears to be a valid, reliable and feasible tool to assess the performance of SPs in an educational setting. [ABSTRACT FROM AUTHOR]