Student Assessment at Yale School of Medicine

Dear faculty, students, staff, alumni, and friends,

As many of you know, in 2010 the Strategic Planning Committee for Medical Education published a set of recommendations designed to renew and refocus Yale School of Medicine's vision for medical education and set clear priorities for moving forward (Strategic Plan for Medical Education). In November I reported to you on our progress in rebuilding our curriculum.

Included within our Guiding Principles for Renewing the Curriculum are emphases on “Assessment and Reflection” and “The Learning Environment”. In light of the Yale System, the question of assessment has long been central to discussions about curriculum, pedagogy, and the culture of our school. Our commitment in the rebuild is to improve our assessment system in a manner that enhances learning and remains faithful to our core values.

Needs Analysis

In 2013, we conducted a needs analysis of student assessment at YSM. This included a comprehensive review of assessment in other U.S. medical schools, the scientific literature, LCME standards, and the assessment strategies that we currently utilize. We also conducted focus groups with students and individual interviews with faculty in leadership positions. I am grateful to Michael Green, M.D., M.Sc., professor of medicine and associate director for student assessment in the Teaching and Learning Center, for his exceptional work in leading this initiative, and to those of you who participated in this effort. The analysis identified both strengths and areas for improvement and laid forth six general principles for student assessment, which will inform our ongoing curriculum rebuild.

Principles and Recommendations

  1. Remain faithful to the values embodied in the "Yale System."
    Assessment in the curriculum will reflect our commitment to a collegial learning environment that respects student initiative and maturity, promotes close faculty mentoring and, importantly, emphasizes collaboration rather than competition.

  2. Promote self-direction and self-regulation in learning and professional development. 
    We will provide students with frequent, meaningful, and actionable feedback about their performance that they can use to continuously evaluate their progress and make efforts to improve their learning.

  3. Emphasize assessment "for learning" while ensuring assessment "of learning."
    Assessment in our curriculum should be considered part of the pedagogy itself, providing students with frequent, formative information essential to promote learning. Use of high-stakes summative assessments will be limited, used to confirm that a student has acquired an established core of medical knowledge and competence in clinical skills.

  4. Assess students using an integrated, developmental, and competency-based approach
    Assessment standards should be clear, based on the stage and level of learning, and should emphasize the ability to correlate and apply knowledge and skills rather than recite information.

  5. Recognize the strengths and limitations of "objective" assessments, grounded in the psychometric paradigm, and "subjective" assessments, which rely on expert judgment in authentic contexts.
    Subjective, narrative assessments, based on the judgment of expert educators and experienced clinicians, offer unique and meaningful insights about the knowledge, clinical competence, and professional development of our students, and should complement more standardized and objective approaches to assessment in our curriculum.

  6. Provide stakeholders with accountable, defensible, and credible affirmation that graduates have met the YSM and accrediting body competency standards.
    Our assessment strategy should be clear and effective, ensuring that YSM students, faculty, alumni, and the administration, along with residency program directors, accrediting bodies, patients, and society at large have confidence in our methods, outcomes, and the quality of our graduating students.

These principles will guide our work in revising the student assessment system at YSM.


Work Under Way

Several initiatives are already under way. In anticipation of the master courses that will be part of the new curriculum, we are piloting formative knowledge assessments with small group reflection in the neurobiology course and neuroscience module. In addition, a committee is exploring ways to leverage the increased continuity afforded by the longer integrated clerkships that will allow longitudinal assessment of clinical skills.

We continue to keep a close eye on the literature and national trends in competency-based medical education. For example, we are currently reviewing the newly released AAMC Entrustable Professional Activities (EPAs) to see how they might be useful in defining developmental standards for our curriculum. Assessment using EPAs is based on the judgment of experienced faculty who observe students performing integrated clinical activities in authentic clinical situations in order to decide when to entrust them with increasing levels of autonomy as their performance improves. 

Once again, I am grateful to everyone whose efforts and thoughts informed our analysis and recommendations. Your feedback will continue to play a critical role as we work to continually improve assessment at our school.

As always, please let me know if you have any questions, comments, or suggestions about this communication or other things we are doing in medical education. You can reach me by e-mail at richard.belitsky@yale.edu or by replying to this e-mail.

Richard Belitsky, M.D

Richard Belitsky, M.D.
Deputy Dean for Education, Yale School of Medicine