To be effective, Medical education needs to set up authentic methods for assessing and evaluating all the domains of learning, based on Bloom's taxonomy. This slide-set is on cognitive domain.

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

2. Determining the Purpose of
Assessment (model: English Language QP)
To prepare a good assessment, one will need to
first identify a clearly defined purpose
(Brualdi1998).
1. What is the learning outcome to be assessed?
2. What should the learner do to prove that the
outcome has been achieved?
3. At what level should the student perform for
the award of various grades/marks?

3. Domains do Overlap – a Disclaimer
Bloom’s
Taxonomic
Domains are
not water-tight
compartments.

4. Cognitive Domain Levels
-------------------Increasing Complexity------------------->
Remember Understand Apply Analyze Evaluate Create
Retrieve
relevant
knowledge
from long-
term
memory
Construct
meaning
from
instructional
messages,
including
oral,
written, and
graphic
communicati
on
Carry out
or use a
procedure
in a given
situation
Break
material into
its constituent
parts and
determine
how the parts
relate to one
another and
to an overall
structure or
purpose
Make
judgments
based on
criteria and
standards
Put elements
together to
form a
coherent or
functional
whole;
reorganize
elements into a
new pattern or
structure
The table above outlines the six levels in the cognitive domain and action-verbs
that can be used to write learning outcomes as well as assess them

5. Timing of Assessment…
• Assessment for Learning: done before teaching-
learning of a lesson/unit/module/block
– to assess the readiness of the learner and the prior
knowledge they already possess
• Assessment as Learning: done during the T-L process
– to enable the teacher to give feedback and guide the
learners on their individual strengths/ weaknesses
• Assessment of Learning: the summative evaluation
done at the end of a lesson/unit/module/block
– to award marks to the students that count toward the final
pass/fail decisions

6. (Evaluation)

7. Assessment & Evaluation compared

8. Dimension of Difference Assessment Evaluation
Timing Formative Summative
Focus of Measurement Process-Oriented Product-Oriented
Relationship Between
Administrator and Recipient
Reflective Prescriptive
Findings, Uses Thereof Diagnostic Judgmental
Ongoing Modifiability of
Criteria, Measures Thereof
Flexible Fixed
Standards of Measurement Absolute Comparative
Relation Between Students
being tested
Cooperative Competitive
Assessment versus Evaluation

9. Methods for Assessing Cognition
• Long Essay Question (LEQ or LAQ)
• Short Essay Question (SEQ or SAQ)
• Multiple Choice Question (MCQ)
• Modified Essay Question (MEQ)
• Patient Management Problem (PMP)
• Oral Examination (viva voce)
• Observational Assessment
– OSCE, OSPE, DOPS (to assess all domains holistically)

10. Disadvantages of Essay Questions
• Cannot test all of the syllabus as items are less
• Students can be rewarded for simply
regurgitating 'all they know' on a topic
• Some students are unable to show their
knowledge due to lack of language skills
• 'Halo effect': the quality of answer just
marked can change expectations of the essay
to be marked next
• Grading can vary from marker to marker so
grades can be subjective

11. Objectivising Evaluation of EQ…
• Essays with action verb that test concepts and
understanding and NOT rote-memory
• Answer key (outline of expected answer)
• Item marking – not answer book marking
• (Alternately) Double correction
– Plus a third one if variation between the two is
beyond permitted range of 10 to 15%

12. Disadvantages of Oral Exam
• Not all candidates perform well in viva voce
• Use of the same questions may lead to later
candidates being “better prepared”
• Questions can get tougher and time per
student less as the day goes on
• Can only deal with a narrow range of skills
• Exams are not anonymous

13. Objectivising Oral Exam…
• Item Cards – random pick up by each student
• Every student gets the same time for the first
round;
• Top rank and Borderline candidates may be
called for a second round
• Each examiner marks independently

14. Feedback for Problem solving Items
• Proficiency Score
– Candidate’s total score as a percentage of
maximum possible score
• Efficiency Score
– Ratio of correct options to incorrect options
chosen by the candidate
• Errors of Commission
• Errors of Omission

15. Summing Up…
• Assessment methods should match
– the predominant domain of the competencies
being assessed and
– the level of performance expected from the
average learner
• The purpose of Assessment (--for learning, --as
learning, --of learning) determines the optimum
timing and frequency of testing for each unit,
module or block (no single best answer!)