Can assessment be a barrier to successful professional development?

Abstract

In recent years, there has been a profound shift towards objectivity in high stakes clinical assessments, to reassure the regulators and the public that our graduating clinicians are competent. However, a recent report has suggested that since the introduction of high stakes assessment the relative levels of patient harm have increased. Although, direct causation has not been claimed it is incumbent upon responsible educators to reflect on the possibility that our students are passing the assessments but the assessments are not sophisticated enough to predict real-world competency. In addition, there has been an increasing focus of the student population on seeing the purpose of their clinical education being to pass assessments, rather than to treat patients. This unfortunate focus likely stems from their school education that develops a fixed task focused mindset. In this manuscript, the authors explore the potential issues over mindset and assessment sophistication, and offer possible solutions to tackle both problems.

Searching our mindset – looking at places and spaces in education

“…It is well established that assessment drives learning and we must acknowledge that assessments can lead to unproductive and unprofessional behaviour that may actually conflict with our ambition to produce well-educated graduates with a range of knowledge, skills and attributes. Dawson and Fox [4] question if assessment can be counterproductive and reinforce a problematic mindset among students. From this starting point, the authors go on to describe an innovative programme approach to assessment successful implemented at a Dental school.…”

Assessment and feedback in dental education: a journey

“…Focusing on assessment is known to be problematic, leading to many unintended and unfortunate consequences in student behaviours. 13 However, presenting sophisticated assessment approaches to students within a framework of development and then requiring them to focus on acting to address their identified development needs would be a more authentic driver of progression. Moreover, progression on this basis is much more in keeping with an ethos of lifelong learning, compared with evidence based on reaching a pass score on a standardised test.…”

Making the case for pass‐fail grading in dental education

“…Most importantly, all of these behaviours confirm the basic tenets of self-determination theory, 19 which suggests that intrinsic motivation is tied to a growth mindset, deep learning, better performance and well-being and is achieved through satisfaction of the needs for autonomy, competence and relatedness, all of which contribute to a humanistic environment. 19,28…”

“…31 Types of assessments at this level include mini-clinical evaluation exercises, mini professionalism evaluation exercises, direct observation and multi-source feedback. 31 These together can potentially assess overall competency through documenting quantitative and qualitative longitudinal data in portfolios 28 and help evaluate "trustworthiness" 31 of the student to perform clinical behaviours in actual clinical settings. For effective pass-fail grading to occur, it is important to have assessments at the levels of this pyramid that can document a student's progress and readiness for practice.…”

“…Fox puts forth a coherent argument that today's dental students belong to a safety conscious generation that struggles to be independent, fears failure, believes grades to be a final outcome and is reluctant to subsequent feedback. 5 Thus, both faculty and students can display a fixed mindset 28 that may not be supportive of the execution of pass-fail grading. The culture at dental institutions needs to support a growth mindset that promotes lifelong learning and resilience in the face of failure by taking the focus away from grades.…”