Assessment in the Era of Outcomes-Based Education

For over 20 years medical education programs across the globe have worked to implement outcomes-based education. A focus on the educational process has now shifted to an emphasis on what a physician is able to actually do at the end of training and at important junctures during the training process. Competencies have become a primary mechanism for defining the educational outcomes of individuals. Outcomes-based education starts with “the end in mind”; in other words, a specification of the competencies (i.e., abilities) that are expected of a physician and needed for the healthcare tasks to be done. These educational outcomes should determine the requirements for the content, context, and structure of the curriculum; the selection and deployment of teaching and learning methods; the site of the training; and the abilities needed of the teachers. Assessment plays a central role in determining whether students, residents, and fellows (or any learner in postgraduate medical education [PGME]) have actually achieved the competencies that have been specified and whether the educational program has been effective in producing the desired outcomes. Competency-based medical education (CBME) highlights the importance of integrating curriculum with assessment; competencies are not independent abilities, but rather, all competencies should be integrated as part of an overall educational system and program of assessment. This change in thinking and the need to assess the diverse and interdependent competencies of the physician has been an important factor in the development of new methods of assessment, especially the work-based assessments covered in detail throughout this book..