Nationwide assessment for students

MOVES towards nationwide benchmarking of medical students’ learning outcomes, rather than a national exit exam, are gaining a foothold in Australian medical schools, say several stakeholders.

A review of the current assessment models for medical education, published in the MJA, covers a selection of collaborative projects which appear to have won the support of the Australian Medical Council (AMC), the Medical Deans Australia and New Zealand (MDANZ), the AMA and medical students themselves. (1)

Unlike the US, where students must pass a national licensing exam before they can practise as doctors, Australian medical schools design, develop and deliver their own exams with little external moderation or comparison with students from other schools, the review authors wrote.

They said accreditation by the AMC provided some reassurance that assessment practices were appropriate in medical schools.

“However, very limited data are available for benchmarking performance against any national standard, or between medical schools in Australia.”

Professor Judy Searle, chief executive officer of MDANZ, told MJA InSight the “endgame” for medical schools was to reassure the public that their doctor was “well trained and well rounded”.

Professor Searle said medical schools had been considering a more collaborative approach with benchmarking for some time.

“[It’s not that the system is broken], I think it’s part of us being better at building the confidence of the public and demonstrating that what we’ve got is good. We can’t just sit back and say it — we have to show it as well.”

Professor David Ellwood, chair of the AMC’s Medical School Accreditation Committee, told MJA InSight that a collaborative approach rather than a national exit exam allowed Australian medical schools to retain their “own flavour”.

“We recognise the diversity of medical education in Australia”, Professor Ellwood said. “There are 19 medical schools and, particularly in the case of the newer ones, there are a lot of different settings represented, including rural and remote medicine. All schools have got their own flavour.

“Given the nature of Australian schools, with their very different approaches, it is difficult to say a single approach will work.

“The first question I would ask [about a national exit exam] as a medical educator is what is the argument for doing it? Will it increase public safety? I’m not sure we have any evidence for that.”

The collaborative approach is being tried in a number of projects including: common clinical assessment instruments; common assessment of clinical sciences and clinical student outcomes; benchmarking performance of schools via a common set of assessment items in the biomedical sciences; and generating databanks of summative and formative assessment items.

Dr Will Milford, co-chair of the AMA’s Council of Doctors-in-Training, told MJA InSight that a collaborative approach was far preferable to an exit exam.

“The fundamental question is one of what they are trying to achieve”, Dr Milford said. “It is unfair to let the individual student be the sole point of assessment and the bearer of the responsibility if the standards are not reached.

“The student is the product of the school’s program, and the school and program should bear responsibility.”

Ben Veness, president of the Australian Medical Students’ Association, said an external exit exam would fundamentally “change the way medical students study”.

“They will work towards the exam rather than focusing on becoming good junior doctors. What type of teaching are we trying to incentivise? Is it more important to spend time in clinical settings learning the practical skills of being a good junior doctor, or memorising [facts and figures]?

“If it isn’t broken, why fix it?”

1. MJA 2013; 199: 578-580