2. INTRODUCTION
• A popular maxim in education is
• IF IT IS NOT ASSESSED IT IS NOT LEARNED.
• Assessment is an important part of the educational process.
It influences students’ learning.*
• Traditionally, assessment has been used to measure the
achievement of students for certification at the end or for
selection. *
3. INTRODUCTION
• The introduction of CBME makes assessment a crucial
element of learning, stress being laid on using formative
assessment to improve learning. Indeed, the emphasis on
competencies makes assessment of their attainment and
maintenance a prerequisite. Assessment must serve both
• To provide the continued input on the progress of the
learner that will allow him/her to calibrate and improve
and also
• To ensure that only the learner with the right set of
knowledge, skills and attitude is allowed to be admitted
into the profession and to provide patient care.
5. Premises
of CBA
• First, teaching and assessment must be in the
context or framework of competencies.*
• Second, discrete assessment of knowledge,
skills and attitudes may not always add up to
a competency*.
• Third, there is a high context specificity in
assessment i.e -> authentic settings,**
6. Features
of CBA
• CBA is continuous and ongoing process with
opportunities for providing developmental
feedback.
• Direct observations of students improve
utility of CBA and feedback.
• CBA should help to acquire
competencies/objectives (Assessment for
learning) and their certification (Assessment
of learning).
• Multiple assessors, multiple tools and
multiple assessments improve the validity
and reliability of CBA.
7. Paradigm
of
assessment
How does assessment differ
Traditional CBA
Mostly summative,
Norm-referenced
Snapshot observ(Term end)->
Tools =proxy
Assessment of learning
Fragmented and mainly focus
on knowledge
High stakes (pass or fail).
Feedback not needed
Both formative & summative
Criterion-referenced
Longitudinal (Ongoing)
Authentic
Assessment for learning
Integrated (knowledge, skill &
attitudes)
low stakes reduce exam
anxiety.
Mandatory
8. FORMATIVE ASSESSMENT
• Formative assessment refers to a wide variety of methods that
teachers use to conduct in-process evaluations of student
comprehension, learning needs, and academic progress during
a lesson, unit, or course. Formative assessments help teachers
identify
• concepts that students are struggling to understand,
• Skills they are having difficulty acquiring, or
• learning standards, they have not yet achieved so that
adjustments can be made to lessons, instructional techniques,
and academic support.
9. FORMATIVE ASSESSMENT
• The general goal of formative assessment is to collect detailed
information that can be used to improve instruction and
student learning while it’s happening.* What makes an
assessment “formative” is not the design of a test, technique,
or self-evaluation, per se, but the way it is used—i.e., to inform
in-process teaching and learning modifications.
• Formative assessments are integral components of
personalized learning and other educational strategies designed
to tailor lessons and instruction to the distinct learning needs
and interests of individual students.
10. FORMATIVE ASSESSMENT
• While formative assessments help teachers identify learning needs
and problems, in many cases the assessments also help students
develop a stronger understanding of their own academic strengths
and weaknesses. When students know what they do well and what
they need to work harder on, it can help them take greater
responsibility over their own learning and academic progress.
11. FORMATIVE ASSESSMENT
• Formative assessments are commonly contrasted with
summative assessments, which are used to evaluate student
learning progress and achievement at the conclusion of a
specific instructional period—usually at the end of a project,
unit, course, semester, program, or school year. In other words,
formative assessments are for learning, while summative
assessments are of learning.
• Information from summative assessments can be used
formatively when students or faculty use it to guide their efforts
and activities in subsequent courses.
12. SUMMATIVE ASSESSMENT
• The summative assessment e.g., university examinations at the end of
professionals, are used for pass or fail decision. The purpose of such
assessments is to sample the learning and ensure quality.
• Since all competencies should be assessed, summative assessments
alone are not the option for CBA. For logistic reasons, competencies
like communication, teamwork, ethics, professionalism and many
procedural skills are also not assessable at term end examinations.
• Ongoing assessment provides many options for this purpose. A
blueprint may be needed to decide which competencies should be
assessed during internal assessment and which should go to
summative or University examinations.
13. FORMATIVE vs SUMMATIVE
• “When the cook tastes the soup, that’s formative assessment. When the
customer tastes the soup, that’s summative assessment.” (Assessment
expert Paul Black )
14. FORMATIVE ASSESSMENT
• The goal of formative assessment is to monitor student
learning to provide ongoing feedback that can be used by
instructors to improve their teaching and by students to improve
their learning. More specifically, formative assessments:
• help students identify their strengths and weaknesses and
target areas that need work
• help faculty recognize where students are struggling and
address problems immediately
15. Feedback
Definition
• “Specific information about the comparison between a
trainee’s observed performance and a standard, given with the
intent to improve the trainee’s performance.”
• Van der Ridder MJM, Med Educ 2008;42:189-97.
16. Feedback
• Competency based assessment aids in the process of learning.
Effective feedback is paramount to helping learners improve.
CBA being an ongoing process , any deviation in learning is
recognized early and taken care of by providing formative
feedback. This concept is crucial and aligns very well with the
basic principles of competency based medical education viz.
active involvement of the learner, creating an authentic
environment for learning, direct observation and provision of
formative feedback.
• CBA requires active participation of the trainee in the form of
self-assessment and reflections
17. Feedback
• feedback is the single most important
factor in promoting & improving learning
• Feedback should be immediate and
authentic
• Feedback must be based on assessment
• Feedback should be available to students
while they still have the time to improve
upon their performance by acting on that
feedback.
18. Feedback in IA
• Feedback should be provided to students throughout the
course so that they are aware of their performance and
remedial action can be initiated well in time. The feedbacks
need to be structured and the faculty and students must be
sensitized to giving and receiving feedback.
• The results of IA should be displayed on notice board within 2
weeks of the test and an opportunity provided to the students
to discuss the results and get feedback on making their
performance better.
• It is also recommended that students should sign with date
whenever they are shown IA records in token of having seen
and discussed the marks
19. INTERNAL ASSESSMET
• Range of assessments conducted by the teachers teaching a
particular subject with the express purpose of knowing what is
learnt and how it is learnt (process of learning). Internal
assessment can have both formative and summative functions.
20. INTERNAL ASSESSMET
• IA overcomes the limitations of day-to-day variability and
allows larger sampling of topics, competencies and skills.
• This assessment gives priority to psychomotor, communication
and affective domains which are usually not assessed by the
traditional assessment methods. . In that way, IA can be a very
useful tool for assessing all competencies in any competency-
based curriculum.
21. INTERNAL ASSESSMET
• It should involve all faculty members of a department (Senior
Residents upwards) and not just one or two senior teachers.
This helps to build the ownership of teaching-learning and
assessment as well as provide ‘hands-on’ experience in
assessment to all teachers
• Involving all teachers in the department and limiting the
contribution of individual teacher, test or tool improves Utility
of IA further.
22. INTERNAL ASSESSMET
• While designing an internal assessment, all domains of learning
i.e., cognitive, psychomotor and affective should be considered
and weightage should be assigned to these domains for
assessment.* We can divide various domains into smaller
components and assign marks to each component.
• As all competencies need to be assessed blueprinting of
assessment is mandatory
• Miller’s pyramid provides a simple way to select appropriate
tool for assessment. Efforts are made to climb higher in the
pyramid
24. INTERNAL ASSESSMET
• A useful approach, especially for affective, psychomotor and
communication domains, is to adopt the concept of assessment
toolbox. Multiple assessment methods should be used to
improve utility of IA. A toolbox is a listing of available tools
(and rating forms, if required), which are suggested for a
particular competency or sub-competency and aims at
improving the value of assessment data. The listed tools are
suggestions only and can be freely used either singly or in
combination by teachers to suit particular requirements.
• Efforts should be made to use multiple tools even for a given
competency to improve validity and reliability of assessment.
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26. Assessment Opportunities
• The assessment opportunities can be broadly divided into
ongoing and term end.
• While the term end examinations (Summative assessment) will
usually be conducted by the Universities, the ongoing
assessments are conducted by the teachers teaching the
subject and can be both formal and informal.
28. Informal opportunities
• Provide the much needed feedback to the learner, helping
them to improve
• Dissociate assessment and decision making,( low stakes)
allowing students to ‘open up’
• Help to take away the stress of assessment
29. Informal assessment
• Informal assessments should happen during teaching-learning activities
with the express purpose of finding out the stage of the student and
taking corrective action in teaching-learning methodology on an ongoing
basis. During lectures, small groups or seminars, use of techniques like
clickers, one-minute papers and muddiest point provide valuable
information to check understanding and provide developmental feedback
• Many of these do not need to be considered for pass/fail decisions but
are useful to aid learning and acquire competencies. These can be
planned by the teachers on a day to day basis and modified depending on
the tasks at hand.
30. Formal opportunities
1. Internal assessment: (midterm & Preterm) How and how much
learnt
2. University examinations: How much learnt; quality control
• Both test different aspects
• One is not a replacement for other
31. Components of IA
(i) Theory IA can include: theory tests, send ups, seminars, quizzes,
interest in subject, scientific attitude etc. Written tests should have
short notes and creative writing experiences.
(ii) Practical/Clinical IA can include:
• Practical/clinical tests,
• Objective Structured Clinical Examination (OSCE)/Objective
Structured Practical Examination (OSPE),
• Directly Observed Procedural Skills (DOPS),
• Mini Clinical Evaluation Exercise (mini-CEX),
• Records maintenance and
• Attitudinal assessment.
32. Components of IA
• Assessment of Foundation Course should be included in
formative assessment of first phase.
• Assessment of Early Clinical Exposure should be included in
formative as well as in internal assessment in first phase
subject-wise.
• Assessment of electives should contribute to internal
assessment in final phase part-2. There should be at least one
assessment based on direct observation of skills, attitudes and
communication at all levels. Communication and attitudinal
assessment should also be built in all assessments as far as
possible. A log book must be used to record these components.
33. Components of IA
• Many of the tools mentioned for IA may appear subjective.
However, by virtue of being high on validity and by conveying a
message to the students to not ignore skills, attitudes and
communication (educational impact), they contribute to better
learning.
• Since stakes at IA are low, the use of expert subjective
assessments to cover areas which are not assessable by
conventional objectivized assessment tools is appropriate.
There is plenty of evidence in literature to suggest that expert
subjective assessments can be as reliable as highly objective
ones.
34. Components of IA
• Internal assessment marks will not be added to University
examination marks and will reflect as a separate head of
passing at the summative examination.
• Universities should guide the colleges regarding formulating
policies for remedial measures for students who are either not
able to score qualifying marks or have missed on some
assessments due to any reason(s).
35. Record keeping
• The peculiarities of CBA, particularly its longitudinal nature and
its use as a measure of progression, require a good record
keeping. Such records can vary from manual to electronic.
• In whatever form they are used, the essential features should
include regularity, availability to the students and a
documentation of discussion of results (present status,
feedback and suggestions for improvement) between the
student and the teacher(s). Many aspects can be covered in a
group feedback while some will require one to one discussion.
36. Record keeping
Logbooks (Format suggested by MCI)
E-portfolios
Regular completion and assessment
Feedback
Will be considered for IA marks (up to 20%
in theory and practical/clinical)
37. Internal assessment ..
- IA should have 100 marks for theory and 100 for
practical except for Medicine, Surgery and OBG
where it should be 200
- Passing in internal assessment will be separately
shown in the final result
47. SUMMARY
The successful use of IA as a tool for promoting learning entails
the following:
• IA has to be based on day-to-day observation of the student.
• It should focus on the process of learning as much as on the
amount of learning.
• It should evaluate competencies which are difficult to assess
through term-end examinations.
• All teachers of the department should be involved in the
assessment process to make for greater reliability.
48. SUMMARY
• 5. The results should be used not only to document the
student’s progress, but also to provide feedback while the
student still has time to improve based on the feedback.
• 6. Meticulous record-keeping is essential for the efficacy and
credibility of the process as also for potential litigation.
49. SUMMARY
• The use of multiple methods, by multiple examiners, in
multiple settings to assess multiple competencies, blueprinting
and longitudinal assessment help to improve the reliability and
validity of assessment.
• Involving multiple teachers in assessment will help in not only
taking care of subjectivity but also provide much needed
training in assessment to senior residents and assistant
professors.
50. FURTHER READING
• Badyal DK, Sharma M. Internal assessment in new MBBS
curriculum: Methods and logistics. Int J App Basic Med Res
2020;10:68-75.1.
• NMC module no. 3 on Assessment
• Regulations on graduate medical Education (Amendment),
2019.
Editor's Notes
*MCQ’s vs Scenario based questions
*In medical colleges stress was on university exam and preuniversity sendup. These used to be high stakes as marks of both were added up in different proportions to university results. IA results were hardly ever shared with students. Blue eyed vs common students. In many places there have been instances of IA being challenged in courts and departments facing humiliation in view of NA of proper records.
The garden analogy to compare the growth of the plant and a learner can provide an important insight into the implementation of IA concept. Here, the gardener takes care of the needs of the plant, observing the leaves, branches, and color of the plant. Same way, the teacher can take care of the growing learner by observing many direct and indirect markers of growth. In this way, IA has the potential to help the teachers provide timely and appropriate remedial action and guide learning.
*Performing competency ‘A’ well does not mean that the student can perform the competency ‘B’ also as well.eg CVS and CNS or BP & Catheterization.
* IV Canula.
**Assessment in demonstration room may not be the same as assessment at the bedside. Moreover, many competencies like communication, team work, sincerity etc. may not be amenable to reliable assessment if done sparingly. Therefore, all competencies need to be assessed multiple times and in different contexts. An implication of this is that only one summative or end of year examination is not suited for this purpose.
The underlying concept of competency – i.e. the habitual and consistent use of knowledge, technical skills, clinical reasoning, communication, emotions, values and reflection in daily practice for the benefit of the individual and the community being served, again demands that the student should consistently demonstrate the desired behaviour rather than only during the final examination.
CBA should help in collecting and analysing evidence to decide if a student is competent in relation to a required competency and in relation to his/her stage of training.
Multiple assessors, multiple tools and multiple assessments improve the validity and reliability of CBA.
Traditional assessments are easy to design, administer, score and analyse compared to CBA but may not be able to provide complete information about the stage of the student’s learning. Being snap shot observations of learning, they are generally not linked to instructions or outcomes and promote test taking behaviour..
CBA, on the other hand, provides more comprehensive information about not only the current stage of the student but also about his progression and ascendency.
CBA is based on direct observation and therefore helps in generation of authentic feedback, which helps the students to learn better.
Many educators contend that formative assessments can only be considered truly formative when they are ungraded and used exclusively to improve student learning. If grades are assigned to a quiz, test, project, or other work product, the reasoning goes, they become de facto summative assessments—i.e., the act of assigning a grade turns the assessment into a performance evaluation that is documented in a student’s academic record, as opposed to a diagnostic strategy used to improve student understanding and preparation before they are given a graded test or assignment.
Formative assessment is an integral part of effective teaching. In contrast with most summative assessments, which are deliberately set apart from instruction, formative assessments are integrated into the teaching and learning process. For example, a formative-assessment technique could be as simple as a teacher asking students to raise their hands if they feel they have understood a newly introduced concept, or it could be as sophisticated as having students complete a self-assessment proforma that the teacher then reviews and comments on.
Traditional assessments are easy to design, administer, score and analyse compared to CBA but may not be able to provide complete information about the stage of the student’s learning. Being snap shot observations of learning, they are generally not linked to instructions or outcomes and promote test taking behaviour..
CBA, on the other hand, provides more comprehensive information about not only the current stage of the student but also about his progression and ascendency.
CBA is based on direct observation and therefore helps in generation of authentic feedback, which helps the students to learn better.
* BP recording or Appendicectomy
Accreditation Council for Graduate Medical Education (ACGME) and American Board of Medical Specialities (ABMS)}
Same can be done during practical/clinical teaching using one-minute preceptor (OMP) or SNAPPS technique (Summarize history and findings, Narrow the differential; Analyze the differential; Probe preceptor about uncertainties; Plan management; Select case-related issues for self-study)
Proper records of the work should be maintained which will form the basis for the students' internal assessment and should be available to the assessors at the time of inspection of the college by the Medical Council of India.
