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| EDITORIAL |
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| Year : 2021 | Volume
: 18
| Issue : 4 | Page : 177-178 |
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Assessment in medical education: Can we pay more attention to formative assessment?
Christopher Imokhuede Esezobor
Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine University of Lagos, Idi-Araba, Mushin, Lagos, Nigeria
| Date of Web Publication | 09-Dec-2021 |
Correspondence Address:
Dr. Christopher Imokhuede Esezobor
Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine University of Lagos, Idi-Araba, Mushin, Lagos
Nigeria
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jcls.jcls_51_21
How to cite this article:
Esezobor CI. Assessment in medical education: Can we pay more attention to formative assessment?. J Clin Sci 2021;18:177-8 |
Medical schools, postgraduate medical colleges, and tertiary hospitals play important roles in the training of medical doctors who occupy an indispensable stratum in region or country's health-care delivery. They provide the medical students and trainee doctors with unique patient encounters that are necessary to achieving the prescribed outcomes in the curriculum. For most resource-constrained countries like Nigeria, the primary source of medical doctors is the nation's medical schools. They simply cannot compete in the labor market of medical doctors; instead, they lose large proportions of their medical workforce to other more resourceful countries every year. The net loss of their medical workforce puts additional pressure on the yet-to-emigrate ones and provides another reason for the training programs to be not only effective but also efficient.
For good reasons, learning encounters in the classrooms, at patients' bedsides, clinics, and communities should be optimized to increase the likelihood that the graduates of our medical schools (both undergraduate and postgraduate) are professionally ready to meet societal demands. Optimizing the learning encounters means significant resources including money and time should be devoted to these activities.
In addition to optimizing learning encounters, assessment should also be equally prioritized in our medical schools; the right assessment should be prioritized. According to Huba and Freed,[1] “assessment is the (systematic) process of gathering and discussing information from multiple and diverse sources in order to develop a deep understanding of what students know, understand, and can do with their knowledge as a result of their educational experiences.” The final examinations such as the MBBS professional exams, the membership (or part 1) and fellowship (or part 2) exams get huge attention and resources devoted to them in our national medical education. For instance, conducting the postgraduate medical examinations in Nigeria takes about 4 months each year. In addition, conducting the examinations requires hundreds of experienced trainers and huge financial resources. The required resources expended attest to the importance of assessment. However, this type of assessment has minimal impact on learning for many reasons. First, summative assessment is done at the end of the training duration. Second, it is performed in a controlled environment that may differ from real-world situations. Third, it is a high-stake, high-stress assessment and leaves little room to provide feedback to the trainees.
This editorial makes a plea that, at this unique period in our nation's medical education journey, formative assessment should regain its importance and be equally given the time, personnel, and financial resources like the ones currently enjoyed by learning encounters and summative assessment such as professional MBBS, membership, and fellowship examinations. In formative assessment, the trainee's learning progress is measured on an ongoing basis, in a setting more akin to real life, and provides many opportunities for feedback. This type of assessment which is learner-centered drives learning and has been credited with significant impact, especially in the medical field where graduates are not only required to “know, know how, but show, and do.” Formative assessment when coupled with effective feedback provides the learners with many opportunities to self-reflect on their experiences and commit to making progress on their learning. Its low stake nature compared to summative assessment further promotes experimentation which is key to achieving the desired outcomes.
Every stakeholder – the trainee, medical educators, school administrator, and government – must be deliberate in returning formative assessment to its rightful place in our medical schools. As medical educators, how much attention do we pay to medical students or doctors when they take history, perform physical examination or procedures, document in medical case notes, or communicate with patients or their caregivers, just to mention a few? Have we left the signing of their logbooks, which is an important attestation, to other trainees and yet we expect the best of their training? As policymakers, school administrators, and government, have we not encouraged payment of little or no tuition while not providing the requisite learning environment, yet we want our graduates to be proficient in many diagnostic and therapeutic procedures?
We must come to the realization that summative assessment is only a means to an end and not the end itself. If we continue to discount formative assessment, then our pass rate will remain abysmal or worse still our assessment will lack external validity.
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