Assessment in Medical Education Focuses Too Narrowly on Test Scores

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For a profession that is often viewed by the public as defining the cutting edge of science, we in medicine have been paradoxically skeptical of change. This reluctance is aptly observed in the archaic methods that we employ in assessing the performance of trainees.
Although our profession is slowly adopting multifactorial assessment techniques, the pinnacle of early-career achievement remains a series of numerical scores on examinations that rely predominantly on the recitation of memorized facts. Not only is this an ineffective way to judge a clinician’s aptitude, it can be counterproductive to developing excellent physicians.
One of my most respected mentors once challenged me to identify the difference between educational activities that are required to obtain test scores, and those that will help develop me into a valued and respected contributor to my field. While there is some overlap, these paths are, by and large, independent of one another. Today I try to impress upon medical students the importance of not ignoring the latter for the sake of the former.
The day-to-day practice of medicine in today’s Information Age is exquisitely reliant on critical thinking and complex problem solving—skills that are not focused on, or readily assessed, in our formal education. Moreover, our obsession with testing facts is ultimately futile, as there exists an overly abundant and ever-increasing body of knowledge that no individual will ever be able to master. A focus on memorizing as much information as possible yields only disciples who can regurgitate facts verbatim. This was of course a crucial skill for doctors in the not-so-distant days of limited access to information. Today there is much more utility in being able to define a problem, either to recall or otherwise quickly access the information needed to solve it, and to employ critical evaluation skills to assess the success of one’s interventions—and, crucially, to be able to know when to change course.
As long as admission to competitive training positions relies largely on rote recall ability, the educational system is robbing our trainees of valuable time and mental bandwidth which could be spent developing them into excellent thinkers and doers. I trust that the latter is ultimately the direction that our profession wants to embrace.
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