Medical Council of India (MCI) implemented competency-based curriculum for undergraduate medical education nationwide in 2019, with assessment of competencies being its integral component. The curriculum has outlined some broad principles and components of assessment, but the process and schedule for formative and summative assessment is to be decided by the universities and institutions. In this document, we summarize the recommendations for the subject of Pediatrics, and propose an assessment model for summative assessment that can be adapted/adopted by universities and institutions. Few basic principles of formative assessment have been shared, the implementation of which may be the main challenge for the institutions. It is important to develop the capacity of the faculty for conducting the assessment under the ambit of principles of competency-based curriculum.

Keywords: CBME, Curriculum, Medical education, University examinations.

Internal assessment, though vital, has been a bone of contention due to its ‘subjective’ nature. However, expert subjective judgments can be as reliable as highly objective　and standardized assessments. A ‘Quarter model’ of internal assessment had been proposed [4] to ensure that no test, teacher, tool or context contributes to more than 25% to the total. MCI recommendations have also proposed a minimum of three tests for pre- and paraclinical subjects and minimum of two tests per professional year for the clinical subjects supplemented by unlimited opportunities for formative ongoing assess-ments [1,5]. It is important to involve all teachers in the department in the assessment process to dilute subjecti-vity, to expose students to different ways of thinking about a problem, and to train junior teachers in assessment. A good record keeping in the form of a logbook or e-portfolio (an electronic document that contains a log of learning activities as well as an evidence of learning from those) is important to provide developmental feedback to the students, especially for clinical skills [6].

A welcome change in the new curriculum is that internal assessment marks are shown separately in the final report and are not added to marks of the University summative examinations. This provides us better opportunities for using internal assessment as multiple low stake assessment to assess acquisition of most competencies. A satisfactory performance in internal assessment (50% combined in theory and practical, minimum 40% in each) is still required to be eligible for appearing for university examinations [1,5]. However, it is simultaneously imperative to develop a feedback mechanism not only to help students acquire the competencies but also to revisit and modify teaching-learning methods and strategies.

There are 406 competencies listed in the subject of Pediatrics out of which 23 are competencies that require certification at ‘Perform’ level (Table I) [7]. As the competency-based system focuses on integration of all domains of learning (cognitive, psychomotor, affective) with communication skills, it is not possible to assess the acquisition of competencies just by internal or intermittent summative examinations. While it is relatively easy to implement the summative component of internal assess-ment, a structured mechanism for formative component with regular monitoring of students’ behavior and assessment of patient records and logbooks remains a challenge. The feasibility-criticality matrix provided in the Skill module [8] of erstwhile MCI can be used as a guideline to classify what should be tested during final examinations and what can be left for internal part. As a general rule, all certifiable skills (Table I) should be included in internal assessment while others can be included in the formative part. Similarly, teacher to student ratio, and availability of patients and skill labs should be considered to decide whether to use real patients or manikins. A high level of motivation and coordination among the teachers is required so that assessment is not taken as a formality or burden but is utilized to monitor acquisition of competencies as well as the department’s teaching-learning program. Up to 20% marks in internal assessment have been allocated to logbooks and this could be used as a handle to encourage formative assessments. Assessment module by MCI [5], serves as a guide for development of formative assessment which may be personalized by respective Universities and institutions using the available resources [9].

A major issue with internal assessment has been ‘subjectivity’ and ‘bias’, which prevents us from making its full use. An earlier proposed quarter model [4] provides useful guidelines. Similarly, many components of programmatic assessment (PA) [10] can also be incorporated, like utility of assessment [11] rather than attributes of individual tool or assessment, and using every assessment to provide liberal feedback to the students. Feasibility and educational impact are important attributes for both formative as well as internal assessment. To obviate the issues of subjectivity and bias, it is better to have all teachers of the department involved in the process [4]. Since senior residents are also considered teachers as per MCI guidelines, they can be used for many formative events, especially those involving procedural skills.

University examinations may not be the ideal way to assess competencies due to logistic concerns. However, they are extremely useful tools to help in quality maintenance and conducting assessment. Graduate Medical Education Regulations (GMER) 2019 [1] and MCI Assessment module [5] lay down the principles and broad structure for the university examinations. Table II summarizes the guidelines from these modules for summative assessment in the subject of Pediatrics [1,5,7]. Different　universities may adopt different combinations of the same. A model for summative examination for undergraduates in Pediatrics is proposed in Box I. The scheme is in consonance with the proposals made by MCI. A key feature of this process would be to assess higher levels of Miller pyramid [12], aligning assessment with the competencies, and analyzing the analytical, synthetic and problem-solving skills of the students. The MCI module on assessment [5] has given few examples, which can be built upon. Examiner orientation, framing scenario-based questions, and having model questions to address various levels of Bloom Taxonomy are some inputs which need to be provided.

Though introduction of competency-based curriculum for undergraduate medical education is a desirable and long-due change, it comes packaged with a lot of challenges. Assessment and documentation of acquisition of competencies will require a high degree of dedication, motivation and input in terms of time and resources, especially in busy clinical departments with perpetual shortage of faculty. The capacity building of the existing as well as new medical teachers is also a huge task. MCI has mandated participation in Curriculum Implemen-tation Support Program (CISP) for all medical teachers [5], which will only be a sensitization. Moreover, the SARS CoV-2 pandemic in the years 2020 and 2021 has posed unique challenges and has interrupted the suggested sequence of teaching-learning and/or assessment for at least two successive batches of undergraduate students. Academic societies can play a definite role in capacity building of faculty and in helping the departments to develop appropriate teaching-learning methods and assessment strategies. As the first step towards uniformity, Indian Academy of Pediatrics (IAP) has already released learning objectives based on MCI competencies [13]. These will be useful for implementation of the competency-based curriculum for the first batch of MBBS students admitted in 2019. The next challenge is to develop an assessment model linked with competencies, especially the formative component in form of its structure, tools (e.g., logbook/portfolio), settings and schedule.

Contributors: PG: conceptualized the paper. All authors contributed to drafting and editing the article, and approval of the final manuscript.

Funding: None; Competing Interests: None stated.

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