Assessment in Medical Education: Time to Move Ahead


  • Piyush Gupta Professor of Pediatrics, University College of Medical Sciences, Delhi, India


EPA, assessment, competencies in medicine.


Assessment is an integral part of the curriculum. However, the assessment tools, devised more than a century ago, have not kept up with changing scenario of health care and demand of the consumers. In the present scenario, what is tested is a one-time assessment at the exit examination as a surrogate marker for real and observable competence. Most Indian medical schools employ the traditional assessment tools that hardly permit testing of most competencies desirable of a physician; i.e., skills in communication, management, collaboration, professionalism, medical knowledge, health promotion, and counseling. Also, the competencies are not assessed in real time situations. A few medical schools have tried to bridge the gap by introducing the second generation tools, yet the overall approach and methodology is fraught with major drawback of fragmentation and non-contextualization. The physician is supposed to satisfy the patient in a holistic manner or in other words, win the trust. It is this trust primarily what needs to be assessed. The present article stresses on the need of a global assessment conducted on an ongoing/periodic basis, with adequate weightage given to the opinion/assessment of the consumer. Utility of some newer tools including mini clinical evaluation exercise (mini-CEX), direct observation of procedural skills (DOPS), multisource (360º), and portfolio based assessment is discussed. Finally, we introduce the reader to the concept of assessment of entrustable professional activities (EPAs). The concept of EPA helps integrate the theoretical concepts of individual competencies into a measurable parameter of Trust.


Batalden P, Leach D, Swing S, Dreyfus H, Dreyfus S (2002). General competencies and accreditation in graduate medical education. Health Aff (Millwood) 21:103-111.

Farrell SE (2005). Evaluation of student performance: clinical and professional performance. Acad Emerg Med. 12:302e6-10.

Cooke M, Irby DM, Sullivan W, Ludmerer KM (2006). American medical education 100 years after the Flexner report. N Engl J Med 355:1339-1344.

Medical Council of India. Vision 2 0 1 5 . A v a i l a b l e f r o m : n c e m e n t / M C I _ b o o k l e t . p d f . Accessed 15 June,2014.

Epstein RM (2007). Assessment in medical education. N Engl J Med 356:387-396.

Ten Cate O (2011). Competency- based medical t r a ining and e v a l u a t i o n . D e f i n i t i o n s a n d correlations with real clinical practice. Revista Argentina de Cardiologia 79:405-407.

Gupta P, Dewan P, Singh T (2010). Objective Structured Clinical Examination (OSCE) revisited. Indian Pediatr 47: 911-920.

Te n C a t e O ( 2 0 0 6 ) . T r u s t , competence, and the supervisor's role in postgraduate training. BMJ 333: 748-751.

Miller GE (1990). The assessment of c l i n i c a l s k i l l s / c o m p e t e n c e / performance. Acad Med 65(9 Suppl):S63-S67.

Klass D (2000). Reevaluation of clinical competency. Am J Phys Med Rehabil 79:481-486.

Leach DC (2002). Competence is a habit. JAMA 287:243-244.

Norcini JJ, Blank LL, Duffy FD, Fortna GS (2003). The mini-CEX: a method for assessing clinical skills. Ann Intern Med 138:476-481.

Dannefer EF, Henson LC, Bierer SB, et al. (2005). Peer assessment of professional competence. Med Educ 39:713-722.

Mathers NJ, Challis MC, Howe AC, Field NJ (1999). Portfolios in continuing medical education-- effective and efficient? Med Educ 33: 521-530.

Challis M (2001). Portfolios and assessment: meeting the challenge. Med Teach 23:437-440.

Challis M (1993). Introducing Apel. London: Routledge.

Ten Cate O (2013). Competency- based education, entrustable professional activities, and the power of language. J Grad Med Educ 5:6-7.

Ten Cate O (2013). Nuts and bolts of entrustable professional activities. J Grad Med Educ 5:157-158

Flexner A (1910). Medical education in the United States and Canada. A Report to the Carnegie Foundation for the Advancement of Teaching. New York: Carnegie Foundation for the Advancement of Teaching.