Assessment In
Medical
Education
Dr. Norhan Sabbah
Assistant Professor,
Medical Biochemistry
LEARNING OBJECTIVES
What is Assessment?
In assessment one is supposed to sit with the
learner. This implies it is something we do ‘with’
and ‘for’ students and not ‘to’ students
(Green, 1999).
Assessment is the process of
documenting, usually in measurable
terms, knowledge, skill, attitudes,
and beliefs.
 Assessment in education is the process of
gathering, interpreting, recording, and using
information about pupils’ responses to an
educational task.
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(Harlen, Gipps, Broadfoot, Nuttal,1992)
Types of assesment
SUMMATIVE
ASSESMENT
FORMATIVE
ASSESMENT
DIAGNOSTIC
ASSESMENT
Final evaluation of
the success in study
Stimulating study
and self-assesment
Initial ability for the
success in study
Domain of learning
1. Cognitive Domain

2.
Psychomotor Domain

3.
Knowledge
Practical Skills
Affective Domain

Attitudes
Bloom’s Taxonomy
LEARNING COMPONENTS
1. KNOWLEDGE
Dose the student or doctor know
what he or she should do?
Communication skill
2. SKILLS
Psychomotor skill.
Is he or she able to do it?
3. ATTITUDE/ RESPONSE
In practice, does the student or doctor
choose to do it when confronted with a
situation?
Clinical competence is demonstrated when a
task is performed using learned skills and
knowledge.
Characteristics' of Good
Assesment
* Validity: The ability of the test to
measure what it is supposed to be
measured.
* Objectivity: The degree by which
learned and independent examiners
agree to the correct answer.
* Reliability: The consistency of the
test scores over time, under different
testing conditions, and with different
raters.
* Educational impact: Examinations drive
learning; this hypothesis describes one of the
strongest relationships in education.
Trainees wish academic success, and academic
success is defined by examinations, therefore
students will do everything to maximize their
chances of success.
The way the exam is conducted also affects
the way students learn. An instrument that
drives students to learn more in depth is said
to have high educational impact.
* Comprehension: The tests should cover
the whole curriculum regarding the testing
of knowledge, skills and attitude
* Practicability: The easiness and feasibility
of the test to be administered.
* Acceptability
* Cost effectiveness
* At the proper level of difficulty.
* Feasibility in terms of time.

break
Steps to construct Ideal Exam
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Identify the purpose of the exam.
Analyze its ILOs.
Design Blue print &Table of specification.
construct questions.
Prepare the Model answer.
Tips for Writing Tests
•
•
Compose test items over time.
Test what you really want individuals to
learn.
•
Create a test bank.
•
Start easy to build confidence.
•
Get feedback on items.
(Nilson, 2010)
Planning a Test

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Use a test matrix or blueprint.
Identify major ideas and skills
rather than specific details.
Use Bloom’s cognitive taxonomy
or something appropriate for
your context.
(Nilson, 2010)
Test Matrix
Quality of the examination
questions
The following criteria must be fulfilled:
1.
2.
3.
Use of blend of questions: There is no single type
which is optimal, but a blend of types can
produce an assessment which is “fit for purpose”.
Use of a suitable percentage of objectively
structured questions (Not less than 70%).
Use of a suitable percentage of questions
measuring understanding and intellectual skills
(Not less than 60%). The exam which tests recall
of knowledge only is no longer accepted
internationally.
4 . Presence of model answers
- Specially prepared model answers


Specially prepared model answers must be
present. They must be clear and readable.
Copied and hand written model answers
are not accepted
For essay question, prepare a rubric. This is
an essential requirement. The rubric is the
detailed model answer prepared by the
examiner. However, it is classified into partitions
according to the allocated marks for each
partition to guide the rater during correction.
The following two items must be
specified by an expert from the
department
(The expert is chosen by the department and from
outside the exam committee & his comments must be
sent in a written form to the assessment unit .
* Number of ILOs covered in the
exam.
* Time feasibility.
Here are types of questions used in
the written exam:
A) Subjective: Short essays (Must be not more
than 30% of questions) {Long essay will not
be discussed, it is forbidden}.
B) Objective: 1) Multiple choice questions
(MCQs).
2) Extended matching questions (EMQs).
3) True/False
4) Problem solving (If properly constructed).
5) Short /restricted answered questions (SAQ/RAQ).
Different types of questions in
the written exam
Short essay question
Advantages:
1) Easy of construction.
2) Presentation of loose ideas in an organized and
logical manner.
3) Enabling the candidate to explore one subject in
great depth.
4) Good for assessment of higher order cognitive
functions including analysis, synthesis and
evaluation.
5) Promotion of critical thinking and the ability to
present arguments succinctly and coherently.
Disadvantages:
1) Relative lack of objectivity and reliability
(even if a structured mark sheet is used).
2) Limited content coverage (as the number of
topics which can be sampled is low because
each answer takes so long time to write).
3) Marking is time consuming.
4) Task may be misinterpreted (Traditional
essay question does not define the scope of
expected answer. The candidates may
interpret the question in different ways).
Rules for writing good essay
items:
“Make sure that”
* Clear and unambiguous wording are used.
* Itemization of the question is done (In each
topic, specify the parts needed to be written
by the student. For example, etiology,
pathology, clinical manifestations or
management…..etc).
* Defined mark for each item is put to make
expectations clear.
* Action verbs are present at the beginning of
the question.

The following are useful action verbs. They are
copied from Bloom’s taxonomy, Bloom
classified the action verbs according to the
level of cognitive function: taxonomy of
action verbs.
1) Remembering
(Memorizing): Define,
enumerate, list, describe, name, label and
compare (If the comparison is offered in a
ready form to students during teaching).
2) Understanding: Interpret, illustrate,
demonstrate, classify, contrast, relate,
summarize, compare (If the student will
construct the comparison by himself/herself),
give reason and explain (Provided it is used
for asking about “Why” or “How”, however, if
used to make the student just describes; it will
be considered among verbs testing just
memorizing).
3) Applying: Solve, utilize, apply, identify
and organize.
4) Analyzing: Analyze, divide, discover and
distinguish (Differentiate).
5) Evaluating: Conclude, criticize, decide,
defend, prove, justify, evaluate and
prioritize.
6) Creating: Compose, construct, create,
develop, design, discuss, formulate and
modify.
N.B.
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Action verbs which are present in level 2
(Understanding) to level 6 (Creating) will be
considered among questions measuring
intellectual skills.
Action verbs related to the last three levels
test are more valuable as they test higher
order cognitive functions. They are more
suitable for years 4, 5 & 6 (Undergraduates)
and for post-graduate students. For example,
you can ask students to “Formulate or design
a plan to manage a disease”.
Meaning of the most
commonly used action verbs
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Define: To give (in precise terms) the
meaning of something. Details are not
required but limitations of the definition
should be briefly cited.
Enumerate: In such questions, student
should recount, one by one, the points
required, in concise form .
List: Similar to enumerate
Name: Similar to enumerate
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Describe: Write the chief characteristics
and specific features of the topic. Student
should characterize, sketch or relate in
narrative form.
Outline: An organized description.
Students should give the main points and
essential supplementary materials,
omitting minor details, and present the
information in a systematic arrangement
or classification.
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Illustrate: A question which asks the
student to illustrate usually requires
him/her to explain or clarify the answer to
the problem by presenting a figure,
diagram or concrete example.
Discuss: Directs student to analyze
carefully and present considerations pro
and con regarding the problems or items
involved. This type of questions calls for a
complete and detailed answer (Not
suitable for undergraduate)
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Summarize: Student should give in
condensed form the main points or facts.
All details and illustrations are to be
omitted.
Compare: Identify the similarities and
differences between two or more
phenomena.
Distinguish or differentiate: The student
should show the differences between two
things in approximately the same class by
determining their distinctions.
Relate: The student should show the
relationship, the answer should emphasize
connections and associations in descriptive
form
Example

Relate the caudate nucleus to the different parts of
the lateral ventricle
Answer:
- The body of the caudate is related to the floor of
the central part
- The tail of the caudate is related to the roof of
the inferior horn
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Demonstrate
Give a practical exhibition and explanation
Example
Diagram of life cycle in Parasitology
Formula in Biochemistry
Experiment in Physiology
 Explain: The student is asked to clarify a topic by
giving a detailed account as to “How and/ or why” it
occurs and whenever possible, the causes are
stated (e.g. explain first aid measures in treatment
of chemical eye injury”
 Justify: The student should defend or show
adequate grounds for decisions or conclusions.
Evidence should be presented in convincing form.
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Evaluate: The student should present a
careful appraisal of the problem stressing on
both advantages and limitations. Evaluation
implies authoritative and to a lesser degree
personal appraisal.
Criticize: The student gives his judgment
about the merits & limitations of theories or
opinions about the truth or facts, and back
his judgment by a discussion of evidence.
Interpret: Student is expected to translate,
exemplify, solve, or comment upon the
subject and usually to give his judgment or
reaction to the problem.
“Avoid”
Using the following action verbs:
1) Discuss: This means that you want the
candidate to analyze the answer and
compare it with those of who agree and
those who disagree (as in thesis) (Avoided in
undergraduate exams but could be used in
postgraduate ones).
2) Write on or write an account on or write
short notes on: These words do not specify
what the examiner needs to evaluate the
candidate in.
3) Mention: This action verb is so confusing
for students, some students interpret it as
the examiner needs the students to just
list names or points, however other
students interpret it as the examiner
needs the students to list names or points
and write comments on each. The same
situation occurs with the raters leading to
lack of fairness in correction. This action
verb is not present in Bloom’s taxonomy of
action verbs.
Recommendations
* To reduce variability in scoring, one examiner
should mark the same question in every
paper. A second examiner (an external or
moderator) should then remark the question
or at least, sample from the top, the bottom
and the mid-range of marks.
* A rubric must be prepared to reduce interrater variability in scoring.
* Make essay questions receive less weightage
during assessment.
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* The action verb “Explain” may be used
to ask the student “How” and in other
situations “Why”. If you want to ask about
“Why”, you can use also “Give reason”.
The latter is familiar to students.
* Use large number of short essay
questions instead of few with great marks.
Using large number of questions increase
the reliability of the exam.