This document discusses ways to improve assessment in education by better measuring student activity and reasoning. It advocates using a blended approach with a spectrum of assessment tools rather than just traditional testing. New techniques discussed include "Hockey Lines" for debriefing and engagement, and "Turk Talk" which uses cues and free text input for hybrid virtual patients. The document also discusses tracking student activity using xAPI standards and doing analysis of student pathways through simulations to identify issues. It acknowledges there is a lot of work needed to generate new assessment questions and cases but sees potential in automated item generation and sharing items through platforms like OpenLabyrinth.