This document discusses optimum methods for assessing the affective domain in medical education. It recommends assessing desirable professional attributes through authentic assessments using real-world tasks. Effective tools include checklists, rating scales, and rubrics. Rubrics are most informative as they describe different performance levels. Authentic assessments include evaluations by supervisors, peers, self, and standardized patients through longitudinal observations, clinical vignettes, and direct observations. Assessing affective outcomes formatively over time using authentic tasks and rubrics best follows the advice to assess important rather than convenient outcomes.

1. Optimum Timing and Methods for
Assessing Affective Domain in
Medical Education
Prof K.R. Sethuraman. MD, PGDHE,
VC, Sri Balaji Vidyapeeth.
Pondicherry 607402. India

2. Dedication…
1901-’82. Coined the popular maxim "Think Globally, Act Locally"

3. Why Assess Affective Domain?
i. to verify competence in the affective domain
ii. to serve as a method to try and change
learner’s behaviour.
iii. to detect undesirable behaviours such as,
abuse of a patient, illegal activity, etc which
warrant immediate suspension from the
educational program

4. What Do We Assess?
• Desirable Professional Attributes
– Displaying honesty and integrity
– Showing respect for patient's dignity and rights
– Maintaining a professional demeanor
– Recognizing limits & when to seek help
– Responding positively to supervision
– Demonstrating dependability and appropriate
initiative
– Interacting with other members of the team

5. Krathwohl’s taxonomy

6. Focus on Higher Levels
-------------------Increasing Complexity------------------->
Receiving Responding Valuing Organization Characterization
Openness to new
information or
experiences
Active participation
in, interaction with,
or response to new
information or
experiences
Attaching value or
worth to new
information or
experiences
Incorporating
new information
or experiences
into existing value
system
Full integration/
internalization
resulting in new and
consistent attitudes,
beliefs, and/or
behaviors
Describe
Follow
Observe
Attend
Identify
Locate
Name
Answer
Assist - Help
Conform
Discuss
Greet
Report
Select
Demonstrate
Follow
Initiate
Join
Justify
Propose
Share
Adhere
Arrange
Complete
Formulate
Integrate
Organize
Relate
Advocate
Display
Practice
Revise
Serve
Solve
Use

7. Authentic Assessment (AA)
• AA is holistic and occurs in real world context
• Tasks simulate real life; therefore meaningful
• Criteria for the assessment known a priori.
• Focuses on the process and the higher-order
outcomes.
• Learning occurs during the formative
assessment via feedback (assessment as Learning)
• Final outcomes can be showcased publicly

8. Assessment: Traditional vs Authentic
Traditional ---------------- Authentic
Selecting a Response----Performing a Task
Contrived ----------------- Real-life
Recall/Recognition ----- Construction/Application
Teacher-structured ----- Student-structured
Indirect Evidence -------- Direct Evidence

9. Methods of Authentic Assessment
of affective domain
• Evaluations by faculty supervisors
• Peer evaluation
• Self evaluation
• Standardized patients (SPs)
• Longitudinal observations
• Clinical vignettes for analysis & decisions
• Direct observation / video recording
• Multi-source Feedback

10. Tools for recording the evaluation
of Affective domain
• Checklist: to identify the presence or absence
of the outcome being assessed (yes/no)
• Rating Scale: to grade the quality of
performance of tasks (process evaluation) or
outcomes (end product) {e.g. 0-1-2-3-4-5}
• Rubric: a tool that has a list of criteria and
description which inform the students what
different levels of accomplishment look like.

11. Checklist
• A good indicator of “Done // Not
done” type of assessment
• Less informative* than rating-scale
or rubrics when assigning a grade
• Checklists are not used to indicate
the relative quality of a product or
performance, which require rating
scales or rubrics
* Partly done is punished or rewarded

12. Advantages of Checklists
• Easy to construct and use.
• Task-focused and task-aligned.
• Effective for self and peer assessment.
• Learners can know the task requirements,
allowing them to self-monitor progress.
• Useful for sharing information with parents
and other stakeholders.

13. Rating Scale
• Requires the rater to assign a value (often
numeric) to the rated object, as a measure of
some rated attribute
• Advantages:
• Simple – eg, convert a Y/N checklist to a 3-point
scale (well done – partly done – Not done)
• Standards for comparative assessment
• Fairness

14. Leadership Checklist & Rating Scale
Mark
Y / N
Well Done Partly Done Not Done
+ 2 + 1 0

15. Rubric
• describes in words the performance that
qualifies for each level, from low to high
(called anchor points)
• Helps us to set reasonable and appropriate
expectations for learners and
• consistently judge how well they have met
them.

16. Well Done Partly Done Not Done
+ 2 + 1 00 +1 +2

17. Advantages of Rubrics
• Describes precise criteria used for grading.
• Supports uniform and standardized grading
among different faculty members.
• Students can understand the rationale for
each grade: what performance qualifies for
what grade in the rubric.
• Helps students to perform better because
they know what to focus on.

18. Disadvantages of Rubrics
• Development can be complex and time-
consuming to create
• Using the correct language to express
performance expectation can be difficult
• Rubrics may need to be revised repeatedly
before it is user-friendly and easy to
administer

19. Summing Up…
• The higher level outcomes of affective domain
take time to be achieved,
• We have to assess them repeatedly in a
formative manner with corrective feedback
• OSCE stations on communication skills with
real or standardised patients are useful
• Well crafted rubrics are ideal assessment tools
to follow Rene’ Dubois’s advice:
– “Assess the important – not the most convenient”