O. ten Cate is professor of medical education and senior scientist, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands; ORCID: https://orcid.org/0000-0002-6379-8780. G. Regehr is professor, Department of Surgery, and associate director of research, Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; ORCID: http://orcid.org/0000-0002-3144-331X.
Acad Med. 2019 Mar;94(3):333-337. doi: 10.1097/ACM.0000000000002495.
Objectivity in the assessment of students and trainees has been a hallmark of quality since the introduction of multiple-choice items in the 1960s. In medical education, this has extended to the structured examination of clinical skills and workplace-based assessment. Competency-based medical education, a pervasive movement that started roughly around the turn of the century, similarly calls for rigorous, objective assessment to ensure that all medical trainees meet standards to assure quality of health care. At the same time, measures of objectivity, such as reliability, have consistently shown disappointing results. This raises questions about the extent to which objectivity in such assessments can be ensured.In fact, the legitimacy of "objective" assessment of individual trainees, particularly in the clinical workplace, may be questioned. Workplaces are highly dynamic and ratings by observers are inherently subjective, as they are based on expert judgment, and experts do not always agree-for good, idiosyncratic, reasons. Thus, efforts to "objectify" these assessments may be problematically distorting the assessment process itself. In addition, "competence" must meet standards, but it is also context dependent.Educators are now arriving at the insight that subjective expert judgments by medical professionals are not only unavoidable but actually should be embraced as the core of assessment of medical trainees. This paper elaborates on the case for subjectivity in assessment.
自 20 世纪 60 年代多项选择题引入以来，评估学生和学员的客观性一直是质量的标志。在医学教育中，这已经扩展到临床技能的结构化考试和基于工作场所的评估。基于能力的医学教育是一个普遍的运动，大致始于本世纪之交，同样需要严格、客观的评估，以确保所有医学学员都达到标准，从而保证医疗保健的质量。与此同时，客观性的衡量标准，如可靠性，一直显示出令人失望的结果。这就提出了这样一个问题：在多大程度上可以确保此类评估的客观性。
事实上，对于个别学员，特别是在临床工作场所，对其进行“客观”评估的合法性可能受到质疑。工作场所是高度动态的，观察员的评分本质上是主观的，因为它们是基于专家判断的，而专家并不总是意见一致——这是有充分理由的。因此，努力“客观化”这些评估可能会对评估过程本身造成有问题的扭曲。此外，“能力”必须符合标准，但它也是依赖于背景的。
教育工作者现在开始意识到，医学专业人员的主观专家判断不仅是不可避免的，而且实际上应该作为评估医学学员的核心内容来接受。本文详细阐述了评估中的主观性问题。
