Foundation for Advancement of International Medical Education and Research (FAIMER), Philadelphia, Pennsylvania, USA.
Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
Med Educ. 2019 Jan;53(1):86-94. doi: 10.1111/medu.13652. Epub 2018 Sep 14.
As the practice of medicine evolves, the knowledge, skills and attitudes required to provide patient care will continue to change. These competency-based changes will necessitate the restructuring of assessment systems. High-quality assessment programmes are needed to fulfil health professions education's contract with society.
We discuss several issues that are important to consider when developing assessments in health professions education. We organise the discussion along the continuum of medical education, outlining the tension between what has been deemed important to measure and what should be measured. We also attempt to alleviate some of the apprehension associated with measuring evolving competencies by discussing how emerging technologies, including simulation and artificial intelligence, can play a role.
We focus our thoughts on the assessment of competencies that, at least historically, have been difficult to measure. We highlight several assessment challenges, discuss some of the important issues concerning the validity of assessment scores, and argue that medical educators must do a better job of justifying their use of specific assessment strategies.
As in most professions, there are clear tensions in medicine in relation to what should be assessed, who should be responsible for administering assessment content, and how much evidence should be gathered to support the evaluation process. Although there have been advances in assessment practices, there is still room for improvement. From the student's, resident's and practising physician's perspectives, assessments need to be relevant. Knowledge is certainly required, but there are other qualities and attributes that are important, and perhaps far more important. Research efforts spent now on delineating what makes a good physician, and on aligning new and upcoming assessment tools with the relevant competencies, will ensure that assessment practices, whether aimed at establishing competence or at fostering learning, are effective with respect to their primary goal: to produce qualified physicians.
随着医学实践的发展，提供患者护理所需的知识、技能和态度将继续发生变化。这些基于能力的变化将需要对评估系统进行重构。需要高质量的评估计划来履行卫生专业教育对社会的契约。
我们讨论了在卫生专业教育中开发评估时需要考虑的几个问题。我们沿着医学教育的连续体组织讨论，概述了在被认为重要的测量内容和应该测量的内容之间的紧张关系。我们还试图通过讨论新兴技术（包括模拟和人工智能）可以发挥的作用，减轻与衡量不断发展的能力相关的一些担忧。
我们专注于评估那些至少在历史上难以衡量的能力。我们强调了几个评估挑战，讨论了评估分数有效性的一些重要问题，并认为医学教育者必须更好地证明他们使用特定评估策略的合理性。
与大多数职业一样，医学领域在应该评估什么、谁应该负责评估内容以及应该收集多少证据来支持评估过程方面存在明显的紧张关系。尽管评估实践已经取得了进展，但仍有改进的空间。从学生、住院医师和执业医师的角度来看，评估必须具有相关性。知识固然是必需的，但还有其他重要的素质和属性，而且可能更为重要。现在投入研究努力来阐明什么是好医生，并使新的和即将出现的评估工具与相关能力保持一致，将确保评估实践，无论是旨在建立能力还是促进学习，都能有效地实现其主要目标：培养合格的医生。
