title: Towards a program of assessment for health professionals: from training into practice.
abstract: Despite multifaceted attempts to "protect the public," including the implementation of various assessment practices designed to identify individuals at all stages of training and practice who underperform, profound deficiencies in quality and safety continue to plague the healthcare system. The purpose of this reflections paper is to cast a critical lens on current assessment practices and to offer insights into ways in which they might be adapted to ensure alignment with modern conceptions of health professional education for the ultimate goal of improved healthcare. Three dominant themes will be addressed: (1) The need to redress unintended consequences of competency-based assessment; (2) The potential to design assessment systems that facilitate performance improvement; and (3) The importance of ensuring authentic linkage between assessment and practice. Several principles cut across each of these themes and represent the foundational goals we would put forward as signposts for decision making about the continued evolution of assessment practices in the health professions: (1) Increasing opportunities to promote learning rather than simply measuring performance; (2) Enabling integration across stages of training and practice; and (3) Reinforcing point-in-time assessments with continuous professional development in a way that enhances shared responsibility and accountability between practitioners, educational programs, and testing organizations. Many of the ideas generated represent suggestions for strategies to pilot test, for infrastructure to build, and for harmonization across groups to be enabled. These include novel strategies for OSCE station development, formative (diagnostic) assessment protocols tailored to shed light on the practices of individual clinicians, the use of continuous workplace-based assessment, and broadening the focus of high-stakes decision making beyond determining who passes and who fails. We conclude with reflections on systemic (i.e., cultural) barriers that may need to be overcome to move towards a more integrated, efficient, and effective system of assessment.
authors.affiliation: Centre for Health Education Scholarship, University of British Columbia, JPPN 3324, 910 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. kevin.eva@ubc.ca.
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Eva
authors.affiliation: University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Georges
authors.initials: G
authors.lastname: Bordage
authors.affiliation: Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada.
authors.forename: Craig
authors.initials: C
authors.lastname: Campbell
authors.affiliation: National Board of Medical Examiners, Philadelphia, PA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Galbraith
authors.affiliation: University of Toronto, Toronto, ON, Canada.
authors.forename: Shiphra
authors.initials: S
authors.lastname: Ginsburg
authors.affiliation: Accreditation Council for Graduate Medical Education, Chicago, IL, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Holmboe
authors.affiliation: Centre for Health Education Scholarship, University of British Columbia, JPPN 3324, 910 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
authors.forename: Glenn
authors.initials: G
authors.lastname: Regehr
mesh_terms: D003162:Competency-Based Education; D004521:Educational Measurement; D006281:Health Occupations; D006801:Humans; D061214:Patient Safety; D058996:Quality Improvement
keywords: Assessment; Competency-based education; Continuing professional development; Health professional education