Formative Assessment in a Credentialing Context

• In Event: Opportunities for Formative Assessment Across Health Professions Education Settings

Abstract

In the context of professional development or lifelong learning, formative assessment can provide both a tool for identifying and addressing gaps in knowledge, skills, or abilities; following Wiliam & Leahy (2007) formative assessment is a tool designed to improve performance. This is a critical issue for licensed physicians who are practicing medicine, as their performance directly impacts patient health and safety outcomes. The promise of an assessment tool that can take good practice to excellent, or identify remediation issues before they impact patients, is attractive to individuals and health systems alike.

A formative tool would allow for individuals who are practicing in a specialized area to engage in assessment and learning targeted to their practice area, as opposed to more general assessments targeted towards competence for independent practice (licensure) or competence to enter a specialty (certification). After specializing it is possible that a physician’s focus could narrow substantially and formative assessment tools would help to keep their knowledge of the broader field up to date while simultaneously allowing them to confirm and develop their knowledge of their specialty area. In this context, formative assessment serves as a tool to guide and complement continuing medical education (CME).

As a concept, formative assessment is often interpreted as customized (or customizable) assessment to address gaps or novel content. In practice this is not necessarily the case, as customizable content, an adequate model for accountability, and an assessment platform for this type of flexible delivery do not yet exist. However the notion is appealing to health systems as a method for ensuring the currency and ongoing education of the physician workforce and also to physicians as a tool for targeted professional development.

Formative assessment tools are less tested tools when credentialing decisions come into play. Though they are potentially powerful for guiding CME and professional development, the idea of assessing performance on “core content” is largely incompatible with a formative delivery system. Current systems of licensure, certification, and maintenance of certification rely on summative assessment tools (in concert with other mechanisms) to ensure that credentialed practitioners have demonstrated adequate mastery of well-defined core content, maintaining baseline knowledge in the physician workforce. When CME and professional development are customizable, however, there is the potential for core knowledge to differ from practitioner to practitioner, with potential negative impacts on patient safety.

This paper discusses the needs and demands of an assessment system for physicians and describes one specialty board’s current practices in formative and summative assessment. The utility of formative assessment in this context is discussed along with recommendations for design and future development.

Authors

• Amanda Clauser, National Board of Medical Examiners

• Ying Du, American Board of Pediatrics

• Cathleen Koenig, American Board of Pediatrics