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Assessment of student learning in Health Professional Education

Assessment is a series of activities that provides detailed information for analysing, discussing, and judging a learners performance of abilities and skills. In the current environment today with large classes, increase diversity of the student population, changing profile of the graduate competencies and increase accountability, all has an impact on assessment practices in higher education 1.

This resource provides information on a variety of assessment methods that are frequently used in health professional education1. 

Purposes of assessment

The main purpose of assessment is to obtain formative or summative information on students’ progress.  Other purposes are to obtain diagnostic information for placement purposes, to monitor throughput rates , to inform external stakeholders and for certification purposes.

Formative assessments are used to provide students with feedback on their progress and to inform lecturers whether students have mastered course material. Formative assessments are typically not awarded marks. Rather, global scores of mastery, oral or written feedback is provided.  Formative assessments are typically situated within courses, not at the end of the course. Formative assessment should not be conflated with continuous assessments, where the marks that are allocated count towards the students’ year marks.

Summative assessments are used to determine students’ progress by the end of a course. Pass/fail decisions are based on marks obtained in summative assessments.

Principles of assessment

·         Validity and Reliability

·         Fairness

·         Feasibility

·         Educational Effect

Norm- and criterion-referenced  assessment methods2,5

In assessment theory, a distinction is made between norm-referenced and criterion-referenced assessments.  The difference between the two theoretical perspectives is important as they yield different types of information about students’ progress, they have different purposes and they are marked or scored differently.  In health professional education, criterion-referenced assessments are frequently used in clinical or work-based settings where the assessment focus is on students’ performance. Norm-referenced assessments are typically used in classroom settings where factual or theoretical knowledge is assessed.

Norm-referenced assessment methods are more traditional and are based on psychometric theory.  In criterion-referenced assessments, student performance is judged on assessment criteria linked to outcomes or competencies.  As pre-specified assessment criteria are explicit and given to the student up front, criterion-referenced methods are more transparent.

Norm- referenced and criterion-referenced assessments are not mutually exclusive.  Both approaches are used in assessment practice and both contribute to the decisions regarding students’ levels of competence. 


1.     Walubo, A., Burch, V., Parmar, P., Raidoo, D., Cassimjee, M., Onia, R. & Ofei, F. (2003). A model for selecting assessment methods for evaluating medical students in African medical schools. Academic Medicine, 78, 9, 899-906

2.     Luckett, K. & Sutherland, L.   (2000). Assessment Practices that Improve Teaching and Learning, in (ed) S. Makoni. Improving Teaching and Learning in Higher Education: A Handbook for Southern Africa. Johannesburg: University of Witwatersrand Press 

3.     Office of Health Sciences Education, Queen’s University (2008)  Improve learning through formative assessment.  The Teaching Doctor: Illuminating Evidence-based Ideas for Effective Teaching

4.     Shumway, J.M.  & Harden, R.M. (2003) AMEE Guide no. 25: The assessment of learning outcomes for the competent and reflective practitioner. Medical Teacher, 25, 6, 569-584

Biggs, J. (1999). Chapter 8: Assessing for Learning Quality: I. Principles. In Teaching for Quality Learning at University. Buckingham: Open University Press.