M edical Teacher, Vol. 21, No.

1, 1999

AMEE Guide No. 14: Outcome-based education:

Part 3Ð Assessment in outcome-based education

MIRIAM FRIEDMAN BEN-DAVID

International Consultant in Medical Education, Jenkintown, PA 190 Y6, USA

SUM M AR Y The role of perform ance assessm ent in outcom e-
based education is discussed em phasizing the relationship and
interplay between these two related paradigms. Issues of the
relevancy of assessment to student learning are highlighted in the
context of outcom e-based education. The im portance of de® ning
assessm ent prem ises and the role of institutions in de® ning their
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The call for performance assessm ent by US national
organizations is actually a call for outcome-based educa-
tion. Proposals of the National Educational Goals Panel
(1991) and the National Council on Educational Standards
and Testing (1992), have both called for national examina-
tions with performance assessm ent as a featured concept

educational philosophy as it pertains to student learning and
assessm ent is also presented. A brief description of im plementa-
tion guidelines of assessm ent prog ram s in outcom e-based educa-
tion are presented indicating the key features of such prog rams.
Introduction
Higher education institutions have been responding to a
growing concern for the adequacy of students’ professional
and career preparation by specifying the outcom es or abili-
For personal use only.
w ith an em phasis on testing c om plex `h ig he r orde r’
knowledge and skills in the setting in which they are actually
used (Swanson et al ., 1995). In order to respond to these
proposals, `higher order’ knowledge and skills need to be
de® ned and incorporated in the instructional design along
with performance assessment methods. Abilities may be
de® ned as short-term behaviors, which are prerequisite to
the next stage of learning; as long-term behaviors linked to
the work place; or both. However, common to all outcom es

based curricula is the desire to demonstrate the credibility

ties critical for future professional performance (Friedman
of the program in terms of what graduates know and can
& M entkowski, 1980). Such outcom e educational programs
do.
focus on assessing performance as well as knowledge as a
The purpose of this paper is to highlight important
key to bridging the gap between college and career.
concepts of assessment in outcome-based education along
Institutions of higher education who set pre-de® ned
the following three topics:
learning outcomes in behavioral objectives dem onstrate
advanced educational reform in teaching , learning and (1) the interplay between assessment and outcom e based
assessment.These programs demonstrate a unique approach program s;
to education by designing a com prehensive system ic (school (2) assessment prem ises in outcome-based education;
wide) and systematic curricula which goes beyond knowing. (3) implementation of assessment programs in outcome-
Outcome-based education and performance assessment based education.
are closely related paradigms. They are bound by simple
educational principles: (1) assessment methods should match T he interplay between outc om e-based education and
the learning modality; (2) in all fairness, students are entitled assessm ent
to learning experiences which will adequately represent the
The design of outcome-based education and student assess-
assessment methods. Consequently, outcom e-based pro-
m ent m ust include consideration of expected student
grams are faced with the need to develop non-traditional
outcome as viewed by different consumer groups. These
teaching and assessment techniques, which capture both
views re¯ ect different needs and expectations. Examples of
the learning and performance of broad abilities. Recent
consumer perspectives are found in faculty expectations
developments in assessment methodology have focused on
from students, future employers or licensure¢erti® cation
performance assessment, and somewhat neglected the related
bodies. Faculty may expect students to master the learning
paradigm of outcome based education. Ideally, at the didactic
m aterial, future employers m ay expect readiness to enter
phase of medical education, where the full scope of profes-
specialized program s and licensure¢erti® cation bodies may
sional development is considered, the two are inseparable.
expect demonstration of general professional competencies.
In such program s, a com prehensive assessm ent will be
By whichever perspective the outcome objectives are defined,
integrated with all stages of the curriculum from its initial
from an assessment perspective, the stakes are not similar.
conception. Furthermore, assessment activities are integrated
Thus, the school decision to satisfy the needs of one or
with learning to enhance student learning from their own
more consumer groups will dictate the nature of the outcome
assessment experience (Loacker, 1993). M edical schools
objectives and the assessm ent program.
have unique opportunities to observe students through their
For exam ple, Brown University School of M edicine
learning and assessment over a prolonged period of time.
(Smith & Fuller, 1994), have developed a competency-
Students are eager to demonstrate their professional growth,
based curriculum which de® nes nine activities: effective
and to monitor their own learning. Thus, clear outcome
objectives, assessm ent-feedback and student self-assessment C or respond ence: D r M iriam F riedm an Ben -D avid, 129 Woo dpec ker Road,
are central to outcome-based education. Jenkin tow n, PA 1 90 Y 6, U SA.

0142-159X/99/010023-03 $9.00 ½ 1999 Carfax Publishing Ltd 23

 M . F riedm an B en-David
communication; basic medical skills; using basic science in
the practice of medicine; diagnosis, management and preven-
tion; lifelong learning; self-awareness, self-care and personal
growth; social and community contexts of health care; moral
reasoning and ethical judgment; and problem solving. In
addition to the nine abilities, knowledge-based require-
ments are grouped into nine categories. Assessm ent criteria
are developed for each activity according to the level of
performance. In contrast, the Society for General Internal
M edicine in its 1996 annual m eeting (Holm boe et al ., 1996)
conducted a workshop to explore current methods in the
evaluation of clinical competence. They present the com-
ponents of the de® nition of a certi® able internist as clinical
judgm ent; medical knowledge; clinical skills; hum anistic
qualitites; professionalism; m edical care; moral and ethical
behavior.
The abilities de® ned by the m edical school and the
certi® cation body present sim ilarities as well as differences.
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Differences m ay stem from the short-term /long-term de® ni-
tions of abilities, the speci® c values of the m edical school
and its educational philosophy, abilities de® ned for the undif-
ferentiated physician and the link between education and
practice.The clearer the de® nition of outcome-based objec-
tives the m ore effective are the assessm ent techniques. The
clarity of the de® nition allows the speci® cation of the nature
of the abilities and the setting in which they are assessed
and, most importantly, how results should be interpreted
(Messick, 1994).
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A ssessm ent prem ises in outcom e-base d ed ucation
The assessment premises adopted by the m edical school are
the re¯ ection of its institutional values. Institutions need to
de® ne their education and assessment prem ises prior to the
design of assessment material. Examples of assessm ent
premises are: assessment is integral to learning; abilities
must be assessed in multiple modes and contexts; content is
the stimulus for learning and it also provides a context to
demonstrate one’ s ability; performance assessment implies
explicit criteria, feedback and self-assessment; core abilities
must be assessed repeatedly over tim e to measure growth ;
assessm ent should be cum ulative and com prehensive;
de® ciencies should be rem ediated (Loacker, 1993).
The New M exico School of M edicine has de® ned in
their assessm ent m anual (1992) guidelines for planning and
implementation of assessment programs in an ability-based
curriculum. The guidelines state that a well-de® ned and
well-managed system of formative and summative assess-
ment should be developed anad implem ented. It recognizes
the importance of developing assessm ent expertise among
faculty and students to enhance the quality of assessment.
Students should assume the responsibility of m onitoring
their own learning progress and a mastery approach to
learning is implemented. Faculty will de® ne standards and
students are expected to meet those standards.
Im plem entation of assessm ent program s in o utcom e-
ba sed education
In planning an assessment program in outcome-based educa-
tion, faculty are undertaking multiple tasks. Examples of
faculty activities are listed here in chronological order. The
list is not inclusive, but it contains important aspects of
assessment program developm ent and implementation.
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(1) Assessment premisesÐ Outline the assessment premises
and the educational philosophy of the institution and
de® ne the relationship between students and faculty, as
well as the responsibilites students are expected to take
to monitor their own learning. O n the other hand, the
school will de® ne its responsibilty to allow students to
meet their educational goals.
(2) Principles of outcom e-b ased educationÐ Establish
outcom e behavior principles, which will consider
consumer groups, short vs long term abilities, the link
between education and practice and the institutional
goals.
(3) De® ne methodsÐ Select the methods by which outcome
behavior s are de ® ne d, suc h as c ritic al inc iden ce
techniques, job analysis, Delphi techniques, national/
professional surveys, faculty/expert judgment or others.
(4) Assessm ent criteriaÐ Develop assessment criteria for
each of the abilities de® ned. The criteria should include
a description of the instructional m ethods employed
for this ability and the setting in which behavior should
be demonstrated. If abilities are described in develop-
mental terms. The speci® c levels should be outlined.
(5) Assessm ent taskforceÐ Establish an assessm ent task-
force, which will include an assessment expert. The
taskforce will coordinate th e developm ent of assess-
ment m aterials and will recruit faculty for the various
tasks. Have faculty from different disciplines wo rk
to g e th e r to allow in te g rati on of ab ilitie s ac ro ss
disciplines.
(6) Systemic assessment program Ð Work towards establish-
ing an `assessm ent oriented faculty’ which will assist in
creating a systemic assessm ent program . O ne which
will reach all institutional aspectsÐ administrative as
well as educational.
(7) Systematic assessm ent programÐ Design a systematic
assessment program, which will ensure uniformity of
assessment across program s.
(8) Flow of assessment informationÐ Indicate the ¯ ow of
assessment information, lines of communications and
how do prom otion decisions and remediation ® t into
the loopÐ and m ake sure the students are not lost in
the process. In an outcom e-based prog ram often
students m ay feel th ey are over tested and under
informed.
Sum m ar y
The list of activities is certainly overwhelming. Faculty
willingness to engage in such an undertaking is the ® rst
indicator of institutional values. Faculty understand that
outcome-based education ensures that students are better
able to meet their learning goals and faculty gain more
insight into the nature of professional behaviors and the
related learning activities. Faculty m ay take on an expert
role in evaluating student performance. Sampling their
subjective judgments over time and over judgments may
provide the statistical con® dence that the evaluation of
clinical abilities is not a matter of an expert’s personal judg-
ment but rather re¯ ects the examinee’ s consistent behavior
(Friedman & M ennin, 1991). It is indeed a win/win situa-
tion.

N otes on C ontributor
D R M IR IAM F R IEDM AN B EN -D AVID is an International Consultant in
M edical Education, 129 Woodpecker Road, Jenkintow n, PA 190 Y6,
U SA.
R eferen ces
F R IEDM AN , M . & M EN NIN , S.P. (1991 ) Rethinking critical issues in
perform ance assessm ent, Academic M edicine, 66, pp. 390 ± 395.
F R IEDM AN , M. & M ENTKOW SKI , M. (1980) Validating Assessment
Techniques in an Outcome-centere d Liberal Art Curriculum Summary,
M ilwaukee, W isconsin, (Alverno College Productions).
H OLM BO E , E.S., H AW KINS , R.E., H AM M ETT , T.W. & M AC KKRELL I-
G AG LIONE , M . (1996) Current Methods in the Evaluatio n of Clinical
Competence. Society for G eneral Internal M edicine annual m eeting.
L OACKER , G. (1993 ) Performance assessment in undergraduate educa-
tion. Paper presented at the AE RA annual m eeting, Atlanta, G A.
M ESSICK , S. (1994 ) The interplay of evidence and consequences in
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For personal use only.
AM EE Guide No. 14, Part 3
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March, pp. 13± 23.
N ATIONAL C OU NCIL ON E DUCATIO N S TANDARD S AND TESTING (1992).
Raising standards for A merican educatio n. Washington, DC: Author.
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U NIVER SITY O F N EW M EXICO S C HOO L OF M EDIC INE (1992) State of
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