Commentary: Adoption of novel approaches towards assessment of ophthalmology residents in the present era.

The word “assess” is derived from the Latin word assidere meaning “to sit beside” and literally, “to assess” means “to sit beside the learner.” Assessment is an integral component of any educational process and is in fact said to be “the tail that wags the (curriculum) dog.”[1] Assessment and learning are mutual driving forces. What is assessed is what gets learnt and whatever is not assessed cannot be assumed to be possessed.

Assessment helps to[2]:

enhance learning through formative function, enabling students to receive immediate feedback, measure their own performance, recognize their strengths and identify areas for development;

provide robust, summative evidence of students meeting the set or desired standards during the training programme;

assess students’ underlying knowledge as well as actual performance in the workplace; and

identify trainees who may need a change in career direction.

Effective assessment is not without challenges. The most common are:[3]

The need to assess amidst busy workplace and/or packed schedules.

Unstructured nature of most current assessments.

Lack of awareness about the need and required know-how of assessments.

The need for change in teacher–learner ethos.

Availability of resources.

Unreceptive trainees not always accepting the provided feedback, especially when the feedback is negative and differs from self-assessment.

Further, subjective assessments can be influenced by assessor’s personal expertise, experience and opinions. Also, assessment ability is an acquired skill and not innate. Therefore, assessor training remains an indispensable part of any assessment programme.

Currently India is passing through an era of educational reforms, with the new competency-based curriculum in place, aimed at producing the Indian Medical Graduate (IMG) who can be locally competent while being globally relevant.[4]

Ophthalmology training programs also need authentic methods of assessment to show that students have learned and can perform what is expected of them upon graduation, and these need to go beyond paper-based tests. A complete assessment should evaluate attitude and behavior in addition to knowledge and skills. George Miller, in 1990, presented a framework in which assessment of clinical competence was not only limited to knowledge, but also extended to skills, attitude, performance and professionalism.[5] This popular Miller’s pyramid consists of 4 sequential levels of assessment beginning at the “know” level (knowledge) followed by “knows how” (competence), “shows how” (performance) and the topmost at the “does” (action) level.[5] Assessment methods targeted at the “shows how” and “does” levels are believed to be the most effective. Unfortunately, all current assessment methods have specific flaws, are inconsistent, and focus primarily on the lower levels of the pyramid which necessitates a need to improve assessment tools and their utility. While oral examination or viva is largely unstructured, not necessarily patient-based, and focusses only on the “knows” and “knows how” levels, the long case method is case specific, examiner-dependent and lacks generalizability.[6] Written and oral examinations are necessary to assess the knowledge domain but other methods are needed to assess the skills and attitude components. Workplace-based assessments (WPBAs) are effective tools which can be used for in-training assessment, i.e., observe skills and performances in authentic settings. The cardinal elements of WPBAs are direct observation, being conducted in the workplace and with an opportunity for immediate, specific, contextual feedback, and thus they can be used for teaching as well as assessment. Most WPBAs are rubrics which contain “dimensions,” i.e., skills needed to perform a task/examination/procedure/surgery; “ratings,” i.e., methods to grade the performance; and “descriptors,” i.e., explanations of the ratings. The ratings could be numerical (e.g., 0–5) or scale such as novice, beginner, advanced beginner, and competent.[7] In their article, the authors have described some important tools for assessing clinical and surgical skills of ophthalmology trainees which not only provide information about the trainees’ level of performance but can also be equal learning opportunities for the students and feedback tools to the teachers, based on which remedial sessions can be planned.[8]

In the entire program of assessment, a carefully selected combination of tools from the “assessment toolbox”[9] and assessor expertise developed through capacity building need to be integrated to allow for an authentic, observation-driven, workplace-based assessment system to be in place.