Everyone wants to know how they are doing, but very few people like being evaluated.
Ronald Epstein, professor of family medicine, psychiatry, oncology and nursing at University of Rochester Medical Center, heard some laughter when he made this observation during his keynote address at Medical Education Day 2014, presented by the Academy of Harvard Medical School. He then suggested reframing assessment as learning, rather than a reflection of learning.
“Every time we assess someone, we are actually engaged in teaching them something, because assessment carries values,” Epstein said. “Assessment is learning.”
This year’s Medical Education Day topic, “Assessment: Getting to the Top of the Pyramid,” built on last year’s focus, which was self-directed learning. Both themes are encapsulated in the redesigned HMS curriculum that first-year medical students will encounter next year, said Richard Schwartzstein, director of the Academy and Ellen and Melvin Gordon Professor of Medical Education at Beth Israel Deaconess Medical Center. Schwartzstein gave opening remarks to a standing-room-only audience in the Medical Education Building’s Walter Amphitheater.
“Many learners think that the real focus of education is just learning a huge compendium of facts, which seems ironic, certainly in 2014, when probably everyone sitting here has a smartphone in their pocket and an iPad and access to facts in an instant,” Schwartzstein said, pointing to knowledge as the foundation of Bloom’s Taxonomy pyramid, which illustrates for educators a way to classify levels of learning and learning objectives.
“We try to drive them, in our education, up this pyramid: to understanding, to applying [knowledge] to solve problems, to analyzing unknown issues, evaluating a scenario and creating a solution, perhaps one that you’ve never seen before,” he said.
Assessments of how well students are accomplishing this can be made using a variety of tools: simulation, the Objective Structured Clinical Examination (known as OSCE), peer assessment, bedside observation, and portfolios of self-reflection and self-directed learning, Schwartzstein said.
Med Ed Day breakout workshops targeted these strategies commonly used for evaluating medical students and residents as they progress from showing knowledge at the base of the pyramid to demonstrating competence at the top.
Epstein described a growing body of evidence that puts assessment of students in the classroom, residents on hospital wards and physicians in practice on a continuum of lifelong improvement. The best way to engage in that process is together, he said, making assessment “a collaborative project rather than a one-way street.”
Collaboration was a theme that also resonated when Epstein was introduced by his HMS classmate and colleague Edward Hundert, Daniel D. Federman, M.D. Professor in Residence of Global Health and Social Medicine and Medical Education, who welcomed faculty on his first official day as dean of medical education.
Hundert thanked Federman, the Carl W. Walter Distinguished Professor of Medicine and dean for medical education from 1989 to 2000, who was in the audience, and he praised his immediate predecessor as dean, Jules Dienstag, the Carl W. Walter Professor of Medicine, for guiding medical education and the Academy through development of the current curriculum and creation of the next new course of study.
Almost 10 years ago, Dienstag delivered a Medical Education Day keynote address articulating his “bold vision” for a complete transformation of the clinical clerkship curriculum, including the introduction of preclerkship courses in social medicine, health care policy and medical ethics, Hundert said, adding that Dienstag’s work set a new standard for medical education.
Dienstag’s legacy will also reach a new generation of students, Hundert said.
“He has led the incredible faculty effort in rethinking of the whole curriculum, an exciting new design that is going to be rolling out for the students arriving in August,” Hundert said.
Turning to Dienstag in the audience, he said, “Thank you for all you have done.”
