Chapter 6: Quality Assurance in Programmatic Assessment

CHAPTER HIGHLIGHTS

ORIENTATION TO THE CHAPTER

Over the last decade, programmatic assessment has gained popularity in health professions education. This modern approach requires new ways of thinking about assessment. Programmatic assessment provides a framework to guide assessment practices, which allows health professions institutes to design their programs optimally for their (educational) contexts. This also means there is no one-size-fits-all implementation of programmatic assessment. The same holds true for quality assurance processes involved in programmatic assessment. In this chapter, the principles and rationale of programmatic assessment are outlined and then followed by three cases with varying implementations. Informed by experiences from practice and the literature, in the last section of this chapter the authors discuss implications for quality assurance through the presentation of overarching themes.

INTRODUCTION—PRINCIPLES OF PROGRAMMATIC ASSESSMENT

A conventional approach to assessment is a modular summative approach. Modules of education are completed with an assessment that needs to be passed based on a minimum passing level. Failing means that the student has to repeat the assessment or ultimately the entire course. Once passed, learners move on to the next module and, when all modules are completed, the learner is considered competent. There are many downsides to this summative approach. It leads to test-directed studying and learning for the test, which is often associated with superficial learning styles [1]. Learned information is easily forgotten. There is little information in the assessment. Typically, grades are used. But grades are extremely poor information carriers [2], which is particularly true for the assessment of complex skills. When additional feedback is given, learners are not inclined to use the feedback in a summative assessment system [3] to regulate their performance. Summative systems of assessment often have few longitudinal components that look at the growth of competence. Finally, individual assessments lead to many false positive and negative pass–fail decisions simply because of measurement error and issues of reliability [4]. The summative approach to assessment is poorly constructively aligned to more modern approaches to learning. Modern approaches to learning are competency-based [5,6]. Competency-based medical education focuses on complex competencies in addition to medical knowledge. These competencies are typically behavioral (communication, collaboration, leadership, etc.) and can only be assessed by observation and professional judgment of that observation in a more longitudinal fashion. Modern education approaches emphasize self-directed learning as a basis for lifelong learning. These modern approaches to education are both seen in classroom teaching as well as in workplace-based learning, but also across all levels of education (undergraduate, postgraduate, lifelong learning). Programmatic assessment is an attempt to better constructively align assessment ...