“Forgetting” after an exam might not be a bad thing
– Written by: Dr. Claudio Violato –
Assessment involves the assignment of numbers, quantities or characteristics to some dimension. Evaluation is the process of interpreting or judging the value of the assessment. Testing as used in the usual sense is a subset of assessment – in the classroom, in the clinic or on the ward it is assessment of educational outcomes. In recent years, the focus for classroom, clinic or ward based assessment has been on performance assessment (also called authentic, direct or alternative assessment). This sort of assessment involves “real life”, open-ended activities that are intended to measure aspects of higher-order thinking and professional conduct which together can be referred to as competence[1].
In psychology and medical education, assessment instruments include examples such as intelligence tests, achievement tests, personality inventories, biomedical tests, and any classroom tests that you have taken in school, college and medical school. All of these are measurement instruments because they attempt to quantify (assign a number) some dimension whether it is length (ruler), time (clock), intelligence (IQ test) or scholastic aptitude for medical school (Medical School Admission Test – MCAT). Each assigns a number to one of a physical (length), psychological (intelligence) or educational / achievement / aptitude dimension (MCAT).
In addition to the MCAT, another very important test in medicine is the Unites States Medical Licensing Examination (USMLE) which is given in steps, reflecting emerging competence over time in the physician’s development. Step 1 assesses understanding and application of important concepts of the sciences basic to the practice of medicine. Here the focus is on principles and mechanisms underlying health, disease, and modes of therapy. Step 2 assesses the application of medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision. Step 3, the final examination, assesses the application of medical knowledge and understanding of biomedical and clinical science essential for the unsupervised, independent practice of medicine, with emphasis on patient management in ambulatory settings. In all cases, scores or numbers are derived from these tests. Tests and assessment devices, therefore, are measurement instruments in education and psychology. Long before systematic or standardized testing in the United States and Europe, however, physician licensing has been rigorously practiced (see Blog Post 1 for historical examples).
Evaluation involves value judgments. To make an evaluation, you interpret a measurement according to some value system. A measurement may be a clinical teacher reporting Jason’s score on a procedural skills test, such as intubation, as 19. If the teacher interprets this score and concludes that Jason is excellent at intubation, then this is an evaluation.
- Assessment = assigning a number
- Measurement = assigning a number
- Testing = assigning a number
- Evaluation = assessment or measurement or testing + a value judgment
Test scores generally serve as measurements or attempts to quantify some aspect of student or clinician educational functioning. The letter grades (A,B,C,D,F) or adjective descriptions (Excellent, Fair, Poor) associated with these numbers are evaluations based on these test scores. In some medical schools, students are provided with a class ranking, which is a type of evaluation because the higher the rank, the better the standing. Evaluation, therefore, is measurement plus value judgments. The quality of the evaluation depends on both the quality of the measurement and the care with which this result is interpreted. A careless interpretation of good quality data is likely to lead to a poor evaluation just as a careful interpretation of shoddy data would. Evaluations by professors (or others) of student performance that are based on little or no data (that is, subjective evaluations) are likely to be of very poor quality. One of our main aims, therefore, is to help course professors, clinical teachers, assessment experts, licensing authorities and others to develop good quality assessments (measurement instruments) and to conduct careful interpretations of the results. Thus their evaluation of student and clinician performance will be enhanced.
Sources:
[1] Hodges B, & Lingard L (eds). (2013) The Question of Competence: Reconsidering Medical Education in the Twenty-First Century. Cornell University Press: Ithaca, NY
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