The Future of Knowledge Assessment

• In Event: The GPS of Medical Knowledge for the 21st Century

Abstract

For several reasons, “pure” knowledge assessment has little future. First, it has never been desirable to assess knowledge in isolation. While the practice of medicine historically has been very dependent on knowledge – it has always been and will continue to be an essential component of the safe and effective practice of medicine, it is best for assessments to focus on application of knowledge, requiring examinees to use their knowledge of “the facts” to accomplish a medical task. This is also true for assessment of foundational knowledge of the basic sciences: the focus of assessment should be application of basic science knowledge to clinical problems. Second, while an understanding of basic science principles and clinical medicine will continue to be important, there is less reason for doctors to commit large amounts of information to memory. Doctors (and patients) commonly use online knowledge resources like UpToDate at the point of care. Knowing when and how to use those resources will become increasingly important.
In part because movements in these directions have already begun, it seems safe to predict at least the following three trends over the next five to 10 years:
• Rather than focusing exclusively on assessments of learning – point-in-time measures of whether learning has occurred, there will be increasing emphasis on assessment for learning in which assessment is viewed as an instructional design problem that is an integral part of the educational program (van der Vleuten & Schuwirth, 2005; Schuwirth & van der Vleuten, 2011; Norcini et al, 2011, 2018). The assessment program is seen as a planned system of individual assessments, each of which may have strengths and weakness, that, taken together, provide the information needed to motivate trainees, guide their learning, and make decisions regarding promotion and graduation. For high-stakes decisions, results of a large number of these assessments will be combined, aggregating information across and compensating for weaknesses in individual assessments.
• There will be increased emphasis on large-scale use of workplace-based assessments, further blurring the distinction between learning and assessment (Norcini & Burch, 2007). This will be particularly true in postgraduate and continuing medical education, where information from patient care activities attributable to specific doctors can be harvested from electronic health records and registries.
• Because of the increasing mobility of the medical workforce, the number of countries instituting national licensing and certification examinations will continue to increase (Swanson & Roberts, 2016). The typical assessment will include both a knowledge and a skills component. The knowledge component will describe patient care situations and challenge candidates to indicate a diagnosis, prognosis, or next step in patient care; candidates will be allowed to access reference materials used at the point of care during test delivery (Lipner et al, 2017). An objective structured clinical examination (OSCE) format will be used for the skills component, with both (standardized) patients and other types of clinical simulations included among the stations used.

Author

• David B. Swanson, American Board for Medical Specialities