Assessment in Health Professions Education

Rachel Yudkowsky, Yoon Soo Park, Steven M. Downing, Rachel Yudkowsky, Yoon Soo Park, Steven M. Downing

• Publisher: Routledge
• Year: 2019
• Print ISBN:
  9781315166902
  9781138054387
• eBook ISBN:
  9781000650433
• Edition: 2
• Topic: Medicine
• Subtopic: Education General

Assessment in Health Professions Education, second edition, provides a comprehensive guide for educators in the health professions—medicine, dentistry, nursing, pharmacy, and allied health fields. This second edition has been extensively revised and updated by leaders in the field. Part I of the book presents an introduction to assessment fundamentals and their theoretical underpinnings from the perspective of the health professions. Part II covers specific assessment methods, with a focus on validity, best practices, challenges, and practical guidelines for the effective implementation of successful assessment programs. Part III addresses special topics and recent innovative approaches, including narrative assessment, situational judgment tests, programmatic assessment, mastery learning settings, and the key features approach. This accessible text addresses the essential concepts for the health professions educator and provides the background needed to understand, interpret, develop, and effectively implement assessment methods.

Part I
Fundamentals of Assessment

1
Introduction to Assessment in the Health Professions

Rachel Yudkowsky, Yoon Soo Park, and Steven M. Downing

Assessment is defined by the Standards for Educational and Psychological Testing (American Educational Research Association, American Psychological Association, & National Council on Measurement in Education, 2014, p. 216) as “a systematic process to measure or evaluate the characteristics or performance of individuals, programs, or other entities, for purposes of drawing inferences.” This is a broad definition, but it summarizes the scope of this book, which presents current information about both assessment theory and its practice in health professions education. The focus of this book is on the assessment of learning and skill acquisition in people, with a strong emphasis on broadly defined achievement testing, using a variety of methods.

Health professions education is a specialized discipline comprised of many different types of professionals, who provide a wide range of health care services in a wide variety of settings. Examples of health professionals include physicians, nurses, pharmacists, physical therapists, dentists, optometrists, podiatrists, other highly specialized technical professionals such as nuclear and radiological technicians, and many other professionals who provide health care or health related services to patients or clients. The most common thread uniting the health professions may be that all such professionals must complete highly selective educational courses of study, which usually include practical training as well as classroom instruction; those who successfully complete these rigorous courses of study have the serious responsibility of taking care of patients—sometimes in life-and-death situations. Thus, health professionals usually require a specialized license or other type of certificate to practice. It is important to base our health professions education assessment practices and methods on the best research evidence available, with rigorous and accountable standards, since many of the decisions made about our learners ultimately impact health care delivery outcomes for patients and the public more broadly.

The Standards (AERA, APA, & NCME, 2014) represent the consensus opinion concerning all major policies, practices, and issues in assessment. This document, revised every decade or so, is sponsored by the three major professional associations concerned with assessment and its application and practice: the American Educational Research Association (AERA), the American Psychological Association (APA), and the National Council on Measurement in Education (NCME). The Standards will be referenced frequently in this book because they provide excellent guidance based on the best contemporary research evidence and the consensus view of educational researchers and professionals.

This book devotes chapters to contemporary theory of assessment in the health professions (Part I: Fundamentals of Assessment; Chapters 1 to 6), practical methods typically used to measure learners’ knowledge acquisition and their abilities to perform in clinical settings (Part II: Assessment Methods; Chapters 7 to 12), and special topics that address innovative approaches to assessment in health professions education (Part III: Special Topics; Chapters 13 to 20). The theory sections apply to nearly all measurement settings and are essential to master for those who wish to practice sound, defensible, and meaningful assessments of their health professions learners; these principles of validity and sound assessment practices resonate throughout the chapters and form the unifying framework of this book. The methods section deals specifically with common procedures or techniques used in health professions education—written tests, oral examinations, performance tests, workplace-based assessments, narrative assessment, and portfolios—that address the diverse and increasingly complex assessment methods for cognitive achievement, clinical performance, and competence in clinical workplace settings. The special topics section describes cutting-edge innovations and tips for health professions education, introducing advances in methods from the key features approach, technology-based simulations, situational judgment tests, programmatic assessment, assessment affecting learning, assessments in mastery learning settings, item response theory, and guidelines for conducting assessment research with statisticians.

George Miller’s Pyramid

Miller’s pyramid (Miller, 1990) is often cited as a useful model or taxonomy of the levels of knowledge and skills assessed in health professions education. In Figure 1.1, Miller’s pyramid demonstrates that cognitive knowledge is at the base, as the foundation for all other important aspects or features of learning in the health professions. This is the “knows” level of essential factual knowledge, the knowledge of biological processes and scientific principles on which most of the more complex learnings rest. Knowledge is the essential prerequisite for almost all other types of learning expected of our learners. Miller would likely agree that this “knows” level is best measured by written objective tests, such as selected- and constructed-response tests. The “knows how” level of the Miller pyramid adds a level of complexity to the cognitive scheme, indicating something more than simple recall or recognition of factual knowledge. The “knows how” level indicates a learner’s ability to manipulate knowledge in some useful way, to apply this knowledge, and to demonstrate some understanding of the relationships between concepts and principles, and may even indicate the learner’s ability to describe the solution to some types of novel problems. This level can also be assessed quite adequately with carefully crafted written tests, although some health professions educators would tend to use other methods, such as oral exams or other types of more subjective, observational procedures. The “knows how” level deals with cognitive knowledge, but at a somewhat more complex or higher level than the “knows” level. The first two levels of the Miller pyramid are concerned with knowledge that is verbally mediated; the emphasis is on verbal-type knowledge and the learner’s ability to describe this knowledge verbally rather than on “doing.”

Figure 1.1Miller’s pyramid

Source: Based on Miller (1990)

The “shows how” level moves the methods of assessment to performance tests, in which one directly observes learner ability to translate knowledge into practice. All performance exams are somewhat artificial, in that they are contrived situations presented in a standard testing format under more-or-less controlled conditions. Simulation-based assessments, such as a simulated patient encounter to assess communication skills, are good examples of the “shows how” level of assessment. Specific cases or problems are pre-selected for testing and special “standardized patients” are selected and trained to portray the case; performance typically is rated using checklists and/or rating scales. Similarly, standardized oral examinations exams can provide opportunities for learners to demonstrate abilities such as clinical reasoning, decision-making, and presentation skills. These standardization procedures add to the measurement qualities of the assessment but may detract somewhat from the authenticity of it.

Finally, Miller’s “does” level is associated with more independent and free-range observations of the learner’s performance in actual patient or clinical settings, known as work-based assessment. Some standardization and control of the assessment sett...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Dedication
• Contents
• List of Figures
• Foreword
• Preface
• Part I Fundamentals of Assessment
• Part II Assessment Methods
• Part III Special Topics
• List of Contributors
• Index