Assessment of Learners in UBC’s Medical Education Programs

The Faculty of Medicine’s MD Undergraduate Program (MDUP) and Postgraduate Medical Education (PGME) programs follow a Competency-Based Medical Education (CBME) framework. In CBME, faculty provide frequent, timely and accurate assessments which are critical to support learners’ development towards achieving required competencies.

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MDUP Assessment Overview

The MD Undergraduate Program (MDUP) follows the principles of programmatic assessment where a mix of methods or modalities are used in each course across the 4-year program to assess learner competencies. This model is integrative, developmental, and provides students with regular and timely feedback.

The Provincial Learner Assessment Team (PLAT) is a dedicated unit within the MDUP, led by the Director of Student Assessment and supported by Leads who provide pedagogical oversight for each assessment modality or pilar. The administrative team within PLAT operationalizes the assessment framework in collaboration with staff at the four distributed sites. The four pillars of assessment are:

 

    • Written Exams
    • Objective Structed Clinical Exams (OSCE)
    • Workplace Based Assessment (WBA)
    • Portfolio

PLAT also prepares student assessment data to enable promotion decisions to be made by the Regional Student Promotions Subcommittee (RSPS), and recommends the assignment of course grades for final approval at the Student Promotion and Review Board (SPRB).

Written Exams

Written Exams are based on multiple choice and short answer questions. Their purpose is to assess applied knowledge related to the learning objectives in a course. 

The resources below will familiarize you with the principles of writing good quality multiple choice questions (MCQs). MCQs follow a basic format with three main components – a question stem, a lead-in question and answer choices. This resource provides guidance on writing and checking MCQs; examples of MCQ ‘Dos’ and Don’ts’ are provided.

The Provincial Learning Assessment Team (PLAT) supports tools that can assist in exam development and recognizes the value of generative AI tools to support learning. The following resource was created with PLAT to support faculty’s choice to adopt generative AI tools to asist with MCQ development.

Download the PDF:

Creating Multiple Choice Questions and Creating MCQs with Generative Artificial Intelligence

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Guide for Inclusive Language

When writing new questions, it is expected that you will review wording for language sensitivity reflective of the current social climate and gender norms. Do not use language that perpetuates negative stigma, shame, or judgement.

The following inclusive language guide is designed to support those teaching in lecture, small group, and clinical settings and highlights current principles, best practices, and examples for applying them, but as language is always evolving, the guide is not all-encompassing.

View or download the PDF: Inclusive Language Guide.

Objective Structured Clinical Exam (OSCE)

Objective Structured Clinical Examination (OSCE) is an exam comprised of a series of clinical stations with simulated patients using using standardized simulated clinical scenarios. Students perform specific clinical tasks such as history-taking, physical examination or counselling, reflective of an appropriate level of skill development.

OSCEs are used to assess clinical competence across all 4 years of training. 

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Training & Support for OSCE in Y1/3 and Y2/4

Students will take OSCEs in each year of their training:

    • OSCEs at the end of Year 1 and 3 include verbal feedback from examiners. Students receive verbal feedback from examiners after each patient encounter. The results are not used for promotion purposes but students who have difficulties will be identified and given additional support.
      • Students receive a detailed score report for each station with written feedback for learning.
    • OSCEs at the end of Year 2 and 4 include more stations than Y1 and 3 OSCEs and do not include verbal feedback from examiners. Results are used to guide promotion decisions and students are required to pass at least 60% of the stations.
      • Students receive a detailed score report for each station with written feedback for learning.

UBC Faculty Development supports faculty through the UBC Introductory OSCE Module and the Examiner’s Workshop training sessions.

Workplace Based Assessment (WBA)

Workplace Based Assessment (WBA) focuses on assessment of students’ demonstrated knowledge, skills and attitudes through narrative feedback. WBA aims to:

 

    • provide on-going, effective verbal and written feedback to students
    • map students’ developmental progression towards achieving MDUP Exit Competencies
    • identify students in need of extra assistance so the appropriate supports can be provided
    • allow assessors to identify students with academic or professionalism concerns
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Components of WBAs and Support for Assessing Learners

In Years 1 & 2, WBAs will be used to assess students’ observed performance in Case Based Learning (CBL), Clinical Skills (CS), and Family Medicine (FM) in MEDD 411/412/421/422 (Year 1 and 2 foundational courses) and Advisor Meetings in MEDD 419 (Year 1 scholarship course). Tutors, preceptors or advisors will be asked to provide feedback through these forms and students will obtain this feedback, once the form is complete.

In Years 3 & 4, WBA is an umbrella term that covers three distinct components:

    • Direct Observation– Completed by the preceptor and/or residents
    • Logging of Patient Encounters and Clinical Procedures/Self-regulated Learning Forms – Completed by students
    • End of Rotation/Elective Assessments – Completed by the designated assessor - Supervisor, Primary Preceptor, Discipline-Specific Site Leader (DSSL)), Clerkship Director, Integrated Community Clerkship (ICC) Site Director, and/or Rural Regional Site Lead (RRSL).

Preceptors are encouraged to honestly assess student performance when they fill out WBAs. While students must achieve course learning outcomes to pass a course, a single WBA is not pass/fail, but rather one data point used in conjunction with other pieces of information to assess a students’ overall performance. A WBA can help a student get the support they need early on.

UBC Faculty Development supports faculty through the Years 3 & 4 Workplace Based Assessment (WBA) Orientation module.

The Years 3 & 4 Resources for Clinical Faculty and Residents curated page provides a comprehensive list of curriculum and assessment resources for Year 3 and Year 4 Clinical Preceptors.

Portfolio

Portfolio is a forward-looking assessment modality structured around cycles of self-regulated learning (SRL). Students intentionally engage in stages of planning and setting goals, tracking, sharing, and reflecting on their own learning and progress in a supported and guided space. Portfolio sessions are supported by Portfolio Coaches across all 4 years of training.

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Portfolio Coach Supports

Students are placed in groups of 7-9 students, each with a designated faculty Portfolio Coach. These portfolio groups meet several times per year year to explore and critically reflect on what students are learning and seeing in practice. Students are required to submit written assignments that coaches provide feedback on.

Portfolio promotes the progression of skills in the four areas:

    • Connections to experience
    • Self-regulated learning
    • Transfer of knowledge and skills
    • Self-assessment & professional growth

UBC Faculty Development helps support faculty with our Portfolio Coach Orientation Module as well as provincial and local workshops.

PGME Assessment Overview

Postgraduate Medical Education (PGME) assessment is based on a competency-based medical education (CBME) model, which is an outcomes-based approach to the design, implementation and evaluation of a medical education program using an organizing framework of competencies (e.g., CanMEDS 2015). The outcomes serve as signposts and frequent, low-stakes assessments from clinical educators track residents’ progression towards competence.

Programmatic assessment in PGME is program specific and assessment methods can involve a mix of tools. Possible assessment methods used in postgraduate training programs include:

    • Workplace Based Assessments
      • Entrustable Professional Activities (EPAs) – Royal College
      • Field Notes – Family Medicine
    • End of Rotation Reports
      • In Training Evaluation Reports (ITERs) – Royal College
      • In Training Assessment Reports (ITARs) – Family Medicine
    • Multisource feedback
    • Simulation
    • Objective Structured Clinical Exams (OSCEs)
    • Written exams

Competency committees review assessment data to make decisions about resident progress based on achievement of pre-determined competencies. Royal College exams for specialties and College of Family Physicians of Canada (CFPC) exams occur near the end of training.

Many assessment methodologies are centered around giving feedback to learners. The Office of Faculty Development has created resources to help support and guide faculty.

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Support for Giving Feedback

How to Give Contructive Coaching Feedback - This resource provides language examples and advice for preceptors offering constructive comments to residents in the Competency By Design (CBD) coaching model.

Common Challenges in Feedback Conversations - This Quick Tips for Teaching microresource offers tips for navigating common feedback challenges.

Giving Feedback After a Direct Observation - This Quick Tips for Teaching microresource offers tips for having a feedback conversation with your learner after a direct observation.

Oh no! Not another workshop on feedback in medical education! - This resource (a PDF summary document and video) explores supervisory strategies to promote feedback across health professional contexts and looks at a variety of feedback approaches relative to learner-faculty shared goals.

Royal College of Physicians and Surgeons of Canada programs for specialist residency are guided by Competency by Design (CBD) for implementation of CBME.
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Support for Resident Assessment in CBD

Competence by Design (CBD) is the Royal College’s multi-year, medical education initiative involving the implementation of the CBME approach to education and assessment in residency training and specialty practice in Canada. CBD embodies the following characteristics:

    • It focuses on expected outcomes
    • It finds a blance between fully time-dependent and fully time-free training
    • It promotes greater accountability, flexibility, and learner-centered teaching
    • It includes broader system-level changes

UBC Faculty Development supports faculty through our Competence by Design (CBD): Resident Training & Assessment module.

The College of Family Physicians of Canada (CFPC) establishes the standards for and accredits postgraduate family medicine training in Canada. The CFPC has developed a system of Continuous Reflective Assessment for Training (CRAFT) to provide a cohesive approach to programmatic competency-based assessment for residents in training.
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Support for Resident Assessment in Family Medicine

UBC Family Practice Postgraduate Program’s Resident Assessment System embraces structures and processes that:

    • Respects that each resident comes with individual strengths and areas for growth
    • Addresses the short length of training with an assessment strategy that both meets program expectations and is bespoke to the individual
    • Has a focus on metacognitive skills (e.g. self-awareness, self-regulation, guided self-reflection) as part of professional development
    • Is founded on the principles of programmatic assessment such that we look at the whole picture across the resident’s training, using multiple low-stakes collaborative assessment points to inform decisions on progress and advancement.
    • Prioritizes transparency and collaboration in both gathering of assessment information and in making decisions on progress.

For a more comprehensive look at assessment in Family Medicine, explore the Assessment page from the Family Practice Postgraduate Program. The resident assessment system is summarized in the Resident Assessment for Learning graphic.