summative vs formative assessments in the medical education curriculum

Formative assessments involve a lot of work for the instructor or the teacher (teach, then design the assessments, carefully evaluate each submission, respond to the student, take further questions, then answer them back and the process continues for some time), and the process continues. I do not doubt that this is the best way to go, and I really wish we had regular formative assessments in our medical college when I was studying. A possible problem wiht formative assessment as the only means of capturing student performance is that it does not give you a predictive validity as to how the student may perform down the line when the role of supervision is taken off. This, I think is a big advantage of the summative assessments, and if you add to it the low workload that it imposes on the tutor, no doubt it has enjoyed such a loyal following among educationists including us medics for a long time.

As I wrote, summative assessments are easy on the teacher/tutor/instructor, and hard on the student in the sense that the onus to do well is on the student now. In other words, you shift the responsibility to the student to show that the student has successfully assimilated all that was needed to learn, plus summative assessments when done well, provide a nice overall summary of the performance of the student to all concerned (ie, regulatory bodies, such as Medical Boards), plus, perhaps it has good predictive validity (I write perhaps only because I am yet to come across a convincing study on the predictive validity of the summative assessment usually offered at the boards exams say for example).

So, while formative assessments are great while the learning is happening, and keeps the learner and the tutor on track as to each other's goals and orientations towards the teaching and learning process, it can get too highly process focused.

Perhaps a combined assessment method blending the best practices of formative and summative assessments is the way to go, I think.

"There's a crack in everything, it's how the light gets in." (Leonard Cohen)

On Sat, Jun 4, 2011 at 11:48 PM, Rakesh Biswas <> wrote:

I agree. Summative assessments ( also called 'the exams') can be a real pain for educationists who follow a constructivist approach.

Formative assessment is the way to go for them ( and i am one of them although i am yet to be able to convince the powers that be to implement it).

Formative assessment that assess a candidate's performance on 'real life' work such as real 'experiences' be it in the lab bench or the bedside. Overall these can be easily collated and assessed ( also verified) if the candidate web logs them on his own on a daily basis.

Once we involve medical students in our 'professional' work so much so that it has the power to influence the outcome of our work ( be it in our laboratory results or our patient care) our assessment of these students is bound to be very real as well as smooth.

Also everyone who does an undergraduate degree in medicine deserves to do an MD clinical residency ( a cylindrical model as in US rather than the pyramid we have).

I wonder how many faculty in this list will agree?



On Sat, Jun 4, 2011 at 5:05 PM, Kaustav Bera <> wrote:

Hmm…guess so but somebody in the decision making body should take a call and eliminate these exams.
Arent there other ways to assess…

On 4 Jun 2011 17:03, "Rakesh Biswas" <> wrote:
> 🙂
> All work may eventually seem to have some use in retrospect.
> On Sat, Jun 4, 2011 at 4:51 PM, Kaustav Bera <> wrote:
>> Stupid burden of exams and writing useless files…missed so many
>> mails…damn it all.
>> Sent from my iPad
>> On Jun 4, 2011, at 4:33 PM, Rakesh Biswas <> wrote:
>> Thought i would for learning purposes (mine) share my attempts to help this
>> patient. I had earlier forwarded his details with attachments and i know
>> opening them can be a deterrent ( email below the current). I had to do some
>> reading of the AHA guidelines on permanent pacemakers and some reflection to
>> collate this response. I hope my Bengali is alright and not too funny.
>> regards, rakesh

>> From: Rakesh Biswas < <>>

>> Date: Tue, May 31, 2011 at 9:17 PM
>> Apnar Holter ECG monitoring o apnar chithite dewa history porlaam.
>> Ami anuman korchi je Holter ECG newar samay apnar kono rokom agyan bodh
>> ebong aswasti hoyni. Tahole Holter ECG te ja change dekha jacche shetar
>> jonye hoyto pace maker nao lagano jete pare.
>> Kintu jehetu apnar aer aagei ekta loss of consciousness ( agyan hoye jawa)
>> hoyechilo ebong jehetu amara janina thik oi samai holter ECG nile ki pawa
>> jeto eta hote pare je sei samai apnar ECG ebong symptoms anujai apnake pace
>> maker lagano uchit hoye uthto.
>> Aekhone eta bola sambhab noi je apni pacemaker na lagale aer paraborti kale
>> apnar abar agyan hawar sambhabano koto ta, tabe hain eta abar howar ekta
>> sambhabona aache jaar jonye apnake sabdhane thakte habe ( Jemone aaguner
>> kaache na jawa, two wheeler na chora o satar avoid kora).
>> Aei anischoiyota theke mukti pawar ekta upai holo pacemaker laagiye newa
>> jeta nischit apnar heart take nijer set kora rhythm a chalito rakhbe.
>> Apnar daktar jehetu apnar bhalo chaan oi jonye uni suggest korechen apni
>> pace maker lagiye aei anishchoyota theke mukti paan. Kintu amar mote apni
>> jodi anischoyota ke face korte paren ebong uparukt sabdhanota abalamban
>> korte paren tahole hoyto etao hote pare je apnar are kono din emnitei
>> problem habe na ( jodio etar chance kom) athoba abar ghana ghana agyan hawa
>> dekha dile apni pace maker taratari lagate badhyo haben.
>> regards,
>> rakesh

>> From: Rakesh Biswas < <>>

>> Date: Wed, May 25, 2011 at 4:12 PM
>> Subject: Medical education (user driven learning) exercise: Clinical
>> problem solving this patient with one episode of syncope

>> To: <>
>> Dear Tabula Rasians,
>> <>

>> In continuation of our attempts to integrate medical education with
>> practice through 'real problems' emailed by 'real patients' i attach (after
>> having taken informed consent) this lengthy document from a patient with

>> syncope who needs to know if he HAS TO have the permanent pacemakeradvised by his physician based on the attached investigations and patient

>> history ( which is in a scanned hand written letter in Bengali).
>> Would be great if we could take time from our busy schedule to help this
>> patient. I guess what we need to look at are the AHA guidelines on permanent
>> pacemaker insertion in the context of this patient? regards, rakesh
>> PS: Perhaps if one of the Bengali students could translate the letter in
>> Bengali for our PCMS, Bhopal students in Tabula Rasa it would be very
>> helpful. I have the patient's informed consent to share this but the
>> attachments are too voluminous to upload in the facebook page. Also we would
>> need to crop them to remove identifiers. However we could upload the useful
>> data selectively to archive at a later date?( after removing the
>> identifiers…a lot of hard work though…its time to have a salaried
>> research assistant for this activity :-)). We also have a current debate
>> going on in the Oxford EBM list serv about pharma and device manufacturers
>> influencing patients and this case represents a sample where our verdict for
>> this patient can actually have a small impact on both the patient as well
>> the device manufacturer ( pace maker manufacturing company) and imagine how
>> the effect can magnify if we start doing this activity with more and more
>> patients and students ( by students i also mean physicians who are now
>> labeled consultants). I am copying this to a few medical educationists and
>> policy makers to have their inputs on both this learning methodology as well
>> as the case ( if they can take time out from their valuable schedule).


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