Twelve tips for embedding assessment for and as learning practices in a programmatic assessment system.

Programmatic assessment supports the evolution from assessment of learning to fostering assessment for learning and as learning practices. A well-designed programmatic assessment system aligns educational objectives, learning opportunities, and assessments with the goals of supporting student learning, making decisions about student competence and promotion decisions, and supporting curriculum evaluation. We present evidence-based guidance for implementing assessment for and as learning practices in the pre-clinical knowledge assessment system to help students learn, synthesize, master and retain content for the long-term so that they can apply knowledge to patient care. Practical tips are in the domains of culture and motivation of assessment, including how an honour code and competency-based grading system can support an assessment system to develop student self-regulated learning and professional identity, curricular assessment structure, such as how and when to utilize low-stakes and cumulative assessment to drive learning, exam and question structure, including what authentic question and exam types can best facilitate learning, and assessment follow-up and review considerations, such exam retake processes to support learning, and academic success structures. A culture change is likely necessary for administrators, faculty members, and students to embrace assessment as most importantly a learning tool for students and programs.