Two years have passed since the introduction of the new competency-based curriculum (CBC). Despite the availability of documents by the Medical Council of India (2019; now National Medical Council) to help the faculty members in implementing CBC, an additional support is warranted, especially for assessing the students meaningfully and effectively. This would help to ensure the quality of medical graduates and judge the worth of changes that have taken place due to CBC, namely integration, professionalism, systems approach, and many other soft skills such as communication. With this background, the second edition of a multiauthored book, “Principles of Assessment in Medical Education” under the editorship of Dr. Prof. Tejinder Singh and Dr. Prof. Anshu, published by Jaypee Brothers Medical Publishers is a welcome addition to the available educational resources.
The objectives of this edition are to improve knowledge and skills of teachers, especially of those from India, regarding student assessment and to make them competent in the use of assessment for learning. What makes this book unique is its focus on assessment, that too in the Indian context. It has its foundation on the principles of assessment as acceptable globally, but at the same time, a thoughtful tilt has been given to the information so that readers can apply them in the Indian setting despite constraints such as a large number of students, limited faculty members, and paucity of time, infrastructure, and funding. It, thus, offers a mix of both, an ideal version of assessment methods with underlying theories and principles and practical tips for applying them in practice.
The contributors of this book are experienced faculty members, who are well conversant with the strengths and shortcomings of the current assessment system. They are also proficient in health professions education and are well versed with concepts, principles, and updates on the topic of assessment. Most of them have been conducting faculty development programs for Indian faculty members from time to time. This gives a confidence that the material in this book would be a distil of their expertise and experience, and they must have taken due care to adjust it to the “right concentration” to benefit a novice or junior member in the field of education.
Almost each and every chapter touches upon CBC, but some chapters have been specifically crafted for the same. For example, the second chapter– “Assessment of Clinical Competence-A Curtain Raiser” sets the base for a reader to achieve more heights in the subsequent chapters. Starting with the construct, the clinical competence, it unfolds its dimensions, clarifies the differences between the assessment for learning, assessment of learning and assessment as learning and stresses upon integrative use of domains while assessing competence. It specifies why multiple methods are needed in different contexts while assessing competence and how they can complement each other when used in combination. Figure 2.2 in this chapter unravels the gist of this chapter-holistic assessment system building.
Chapter 6-Question Paper Setting delineates how to use tools for knowledge assessment effectively. The authors have walked the readers through different steps of question paper setting. It also covers blueprinting. The tables showing allocation of weightage to content and the blueprint are updated as per the present CB curriculum.
Another new chapter entitled “Direct Observation-based Assessment of Clinical Skills” (Chapter 9) provides a range of assessment tools for the components of competencies (such as skills, reasoning, communication, attitude, and professionalism) that can make the assessment authentic and take it to the level of “shows how” or “does.” The salient features of these tools have been presented along with a comparative table regarding implementation requirements, assessment attributes, and major strengths and limitations [Table 9.3]. This offers an opportunity for the readers to make need-based selection.
Chapter 13 on Workplace-based Assessment (WPBA) offers a perfect blend of theory and practice. Harping on the shortcomings of conventional assessment, the author has illustrated how solutions can be sought into WPBA. The highlight of this chapter is step-wise approach to set up WPBA. The use of quality parameters and necessity of faculty development are also emphasized. There is a discussion on potential problem areas in WPBA. In the Indian setting, WPBA is still in infancy, and this chapter will be a guiding light for many faculty members irrespective of the discipline.
The concepts underlying competency-based assessment have been reinforced in Chapter 14. It emphasizes longitudinal, continuous assessment of competencies, which are achieved over a period. This chapter illustrates the role of entrustable professional activities (EPAs), milestones and deliberate practice when novice learner progresses to an expert. Clearly explained concepts, three-dimensional model of CB assessment, [Figure 14.3] and examples of different EPAs deepen the understanding that competency-based assessment is all about assessment for learning.
Three chapters, namely Assessment for Selection (Chapter 17), Internal Assessment (Chapter 19), and The Quarter Model (Chapter 20) are based on the earlier publications of the authors. Chapter 17 compares the selection process followed for admission in the USA, Canada, UK, and India. It is a bird's eye view about high-stakes national-level examinations. It also provides critical appraisal regarding the National Eligibility Entrance Test and the National level examination in India to select students for UG and PG courses. Of the other two chapters, The Quarter Model is a new one which proposes a model for “in-training assessment” giving examples for physiology and pediatrics. Many features of programmatic assessment, which have been described in Chapter 18 are incorporated in this model.
Programmatic Assessment, yet another key Chapter, beautifully narrates the conceptual model of an assessment plan that is longitudinal, spanning the years of the entire educational program. It describes rationale, explains principles, provides comparison with traditional assessment, describes practical implications, and unfolds plans for its implementation highlighting the challenges. Most importantly, it illustrates how programmatic assessment can be incorporated in the current Indian curricular setting. I shall reiterate the plea of the authors to use the flexibility provided by the regulatory authority and devise plans for programmatic assessment, which would be a meaningful assessment for CBC.
I feel many readers will appreciate the Chapter on Assessment in Online Settings (Chapter 21). In the last 1½ year of COVID-19 pandemic, there was no option but to resort to online teaching-learning and assessment. This has raised many reactions, concerns, and queries from teachers as well as students. Answers to those lie in this chapter. This chapter not only states principles for designing an online assessment but also provides question formats for the same, guides how to ask higher-order questions, and provides examples of patient management problems as clinical learning exercises. It gives assurance that assessment in the clinical setting can be conducted taking due precautions.
Feedback serves as an integral part of learning and professional development and of course, is the backbone of this new curriculum. Chapter 24, educational feedback to students, is a treat to read as it takes you from the basics of feedback to ways and strategies for its incorporation in the current UG curriculum and enhancing its value.
As faculty members, we do get carried away by the objectivity of assessment tools. Chapter 26 entitled, Is “Objectivity Synonymous with Reliability?” makes one think deeply about assessment measures and purpose served by them. It argues in favor of “subjective” expert judgment and makes you realize that we need to reintroduce it in our assessment and yet to maintain the rigor.
In this edition, there are two chapters with new authors-”Portfolios for Assessment” (Chapter 11) and “Community-based Assessment” (Chapter 15). The chapter on portfolio provides a sound example of how to write reflection that can guide readers to train their students for writing reflection. It also discusses how to assess reflection and presents standardized guidelines for the same. Chapter on Community-based Assessment apart from the narrating features specific to community setting provides Worley's framework for assessment. It also displays different assessment tools that can be used for different axes of this framework for both formative and summative assessments [Table 15.1]. A reader may find that the assessment tools described in this chapter have been described elsewhere too in this book. Such repetition is unavoidable to complete the picture. Moreover, some additional points, for example, the use of rubrics to assess reflection, are also gained.
“Online Resources for Assessment” (Chapter 28) has undergone a lot of revision to make it relevant to today's scenario. The resources presented are aptly categorized, for example, learning platforms; for creating, distribution, and grading of assessments; tools for formative assessment and student engagement; for gamification; to create interactive videos; opinion polling and surveys; e-portfolio; online collaboration; for Objective structured clinical examination (OSCE), simulation; to create rubrics and as if this list is not enough, also for high-stake examination, online security, and proctor device. These categories pertain to the various topics covered in this book. A reader can select any resource depending on the tool of his/her interest, click on the link provided and get familiarized with it.
Chapter 16-”Assessment for Learning” is also extensively revised with many illustrations which bring in concept clarity regarding its attributes. Due emphasis on feedback and educational environment is given along with practical tips regarding how to avail opportunities for the assessment for learning and how to incorporate it in UG curriculum.
Long case was a component of conventional assessment in the Indian setting and has still retained in the current CBC. This chapter discusses strategies to overcome its shortcomings. The modifications in OSCE such as Group OSCE (GOSCE) or Team OSCE (TOSCE), will help the faculty to incorporate peer and faculty feedback. In the setting of high student: teacher ratio or when institution is catering to students from multiple disciplines (both situations common in Indian colleges) GOSCE and TOSCE, respectively, are welcome introduction at least for formative assessment. The other innovations in OSCE are also interesting. The chapter on “Oral examination” (Chapter 10) has been revised to include structured oral examination along with a sample plan of the same for the final year students. Furthermore, a brief on multiple mini-interviews has been added.
The additions such as professional identity formation in the Chapter on “Assessment of Professionalism and Ethics,” point-biserial correlation in the Chapter on “Item analysis,” standard setting for clinical/practical skills in the Chapter on “Standard setting,” generalizability of student rating of faculty teaching and its uses and misuses in the Chapter on “Students Rating of Teaching Effectiveness,” and the changed model of faculty development program in the Chapter on “Faculty Development for Better Assessment” rekindle reader's interest in these chapters.
While reading this book, at times, I wondered about the order in which the chapters have been arranged. However, that is an editors' personal choice and may not affect reading of the book.
Apart from the academics, what I personally liked in this edition is the display. It is eye-catching and makes a pleasant impression on the mind. The selection of light and dark blue colors, blue headlines to indicate sections, bold subtitles, clear tables and boxes, bicolored flowcharts/diagram compels you to move through the text swiftly. The illustrations in the chapters are supportive to understand the concepts. They are meaningful and not just the repetition of what is there in the text.
The language is simple, easy to understand, and despite being a multiauthor book, the information flows cohesively. No doubt there is a repetition of information at times, but as I pointed out earlier for one of two chapters, it helps in emphasizing certain points or complements earlier write-up. Each chapter starts with key points and ends with not just the references which are cited in the text but also a list of articles for further reading to quench the thirst of motivated readers. Moreover, each chapter offers the reader something to put into use, may it be a checklist, formula, framework, and example to follow or list of things to be avoided.
I would like to recommend this book to all the stakeholders of medical education. It has something or the other for each one of the faculty members, administrators, policymakers, and even the students. It will also cater to the needs of other health professional disciplines.
However, words of caution for all those who wish to read this book. As stated by Francis Bacon, the English philosopher, statesman, and jurist,
“Some books are to be tasted, others to be swallowed, and some few to be chewed and digested; that is, some books are to be read only in parts; others to be read, but not curiously; and some few are to be read wholly, and with diligence and attention.”
─Francis Bacon, The Essays, Chapter 50, P 102
I strongly feel that this book belongs to the last category, for which one should take out time, both for reading and assimilation. More importantly, the learning should not remain as mere gain in knowledge; it should be applied in practice. I am sure that must the expectation of the editors and all the contributors. So hopefully, this book will be seen in near future on the shelf of not just the institutional/departmental library but with every person who has interest in success of the CBC program for the betterment of our Indian Medical graduates.