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Assessment in Medical Education

Staff

A glance at the current issue of The New England Journal of Medicine: Testing medical residents

Faculty members charged with evaluating medical students and residents should use a variety of methods, including peer evaluations, multiple-choice tests, exercises with high-tech simulators and mannequins, and observed encounters with actual patients and actors posing as patients, writes Ronald M. Epstein, professor of family medicine and psychiatry at the University of Rochester Medical Center.

Such an approach would provide a well-rounded view of the trainee and compensate for flaws in any single assessment method, Dr. Epstein says.

For instance, a faculty member could observe the student interacting with several patients and watch the same student examining a series of actors playing the role of patients. The latter exercise could be followed by an oral examination that tested the clinical skills the student demonstrated in the standardized setting.

Another day, the student could take a multiple-choice exam or write essays that required him to synthesize medical literature on diseases he has encountered. Yet another test would be to have the student's peers judge his interpersonal skills and work habits.

Dr. Epstein notes both strengths and weaknesses in the various methods used to assess students and trainees, along with their unintended consequences. For instance, a physician's observations of a trainee can be subjective, while interactions with standardized patients, which have been required since 2004 on the United States Medical Licensing Examination taken by all senior medical students, can seem artificial, he says.

Multiple-choice tests, while easy to administer and grade, introduce the possibility that students who would not otherwise know the answer will get it because they have seen it in the list of choices.

"This effect, called cueing, is especially problematic when diagnostic reasoning is being assessed," Dr. Epstein writes, "because premature closure -- arriving at a decision before the correct diagnosis has been considered -- is a common reason for diagnostic errors in clinical practice."

The article, Assessment in Medical Education is available on the journal's website in pdf file.

— staff
Chronicle of Higher Education
2007-01-26
http://chronicle.com/cgi-bin/printable.cgi?article=http://chronicle.com/daily/2007/01/2007012601j.htm

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