How should clinical work be assessed?

Clinical studies can be assessed by a variety of means. Common forms of assessment include:

• case study or report
• learning journal or ‘log’
• presentation
• portfolio of work
• observation and evaluation of performance in the clinic

or some combination of these. Note that few of these methods are unique to clinical instruction, but all are geared to reflecting the experiential nature of the clinical process. There are a number of relevant and useful discussions of assessment issues in, for example, Brayne, Duncan & Grimes (1998); Hinett (2002); Kibble (1998) and Macfarlane (1998).

Much of the discussion at a basic level boils down to three key decisions, the answers to which in turn depend ultimately on your educational values and objectives for the programme.

Do you want your assessment regime to emphasise the students’ developmental learning process, or the work product they have finally created, or both?

(This is not to suggest that there is a right answer, but simply to stress that the answer makes a difference to what you assess and how.)

For example:

• learning logs are good at encouraging students to describe and analyse their own processes; they are not really a measure of work product
• performance evaluation tends more readily to measure outcomes rather than learning processes (I know this latter assertion is a bit of a generalisation, but my justification involves some rather complex cognitive issues, which I would be happy to discuss by e-mail, rather than here!)
• portfolios can provide a means of assessing a mix of process and product – see my teaching resource note on portfolio-based assessment

Should reflection be formally assessed?

Really there are three issues here. First, do you want students to reflect on their performance in clinic (hint: the answer is almost certainly ‘yes’ for the reasons laid out by the voluminous literature on notions of reflective practice).

Second, do you want formally to assess it? This is a more sensitive issue. There are some who question the propriety of assessing personal reflection on learning, not least because it is highly personal and developmental and because it can raise difficulties around parity and validity of assessment decisions. On the other hand, there are those who are prepared to confront those problems and assess reflection because they take the view that it provides a reliable source of data on individual developmental learning (see further Hinett, 2002, and the examples therein).

Thirdly, there is the question whether, if you do assess reflection, you should attempt to grade it or simply make it a requirement of completing the module. Again, opinion is divided on this, and the debate tends to revolve around broadly the same issues as the prior question of whether or not to assess reflection in the first place.

Are you satisfied that you can avoid major problems of reliability and comparability in assessment (cf question 4)?

These problems are most pronounced in externship programmes, where the university may have less control over the range and depth of learning experienced by students. They are least acute in simulation clinics, where assessment can be more readily standardised and normalised. In reality, most clinicians tend to the view that the issue is not about reliability in any deep sense, it is an organisational problem which can be overcome by a fair distribution of work which can be assessed against transparent and reasonably objective standards and criteria, supported by consistent supervisory practices.

Last Modified: 2 August 2010