We thank Dr Atreja for making suggestions to improve the
utility of quarter model for in-training assessment (ITA).
He has suggested adding workplace based assessment (WPBA) to
improve the applicability of the model.
While there are similarities between the
two, there are important differences as well. ITA operates
at the level of ‘competence’ (what the student is capable of
doing) while WPBA operates at ‘performance’ (what the
trainee actually does). ITA has been proposed basically for
undergraduate medical students. Since undergraduates are not
directly responsible for patient care, many of the tools
used for WPBA are not applicable to them. At the
postgraduate level; however, it is possible to use case
based discussions (discussing the cases actually managed by
the trainee and seeking justification for what had been
done), DOPS and multisource feedback. In addition, sheer
numbers will make it difficult to organize these types of
assessments for undergraduates.
We do not agree with the contention that
using more objective assessments will make such assessments
more robust. There is enough literature support to tell that
objectivity is not sine-qua-non of reliability or
validity [1]. Expert subjective judgments can provide as
much or sometimes even more reliable information about
trainee performance [2]. The tools mentioned in the letter
(mini-CEX, DOPS, MSF etc.) are very subjective compared to
say OSCE - yet they have been accepted as highly useful in
providing information about performance of the trainee.
Since the purpose of ongoing assessment is to provide
feedback to the trainee/students, reliability is not really
as much of an issue as educational impact of such
assessment. Conversely, subjectivity and individualized
feedback is considered a strength of mini-CEX [3] which
helps the trainees see cases from different perspectives.
The reasons for flawed implementation of
internal assessment in our country are related to inability
to make appropriate use of such assessments. Teachers hardly
provide any feedback to the students to improve their
performance and most such assessments end up as replica of
conventional examinations without clarity of purpose. The
solution lies in faculty development and letting the
students experience the utility of formative feedback in
helping them improve rather than using more objective
assessments.
1. van der Vleuten CPM, Norman GR, De
Graff E. Pitfalls in the pursuit of objectivity: issues of
reliability. Medical Education. 1991;25:110-8.
2. Singh T. Objectivity and reliability
revisited. In: Singh T and Anshu (Eds). Principles of
Assessment in Medical Education. 1st ed. New Delhi: Jaypee;
2012.
3. Norcini JJ. Current perspectives in assessment: the
assessment of performance at work. Medical Education.
2005;39:880-9.