“The ability to secure meaning in the course of our experience is a basic human need… But meaning is not simply found; it is constructed.” – Elliot Eisner

A few days ago I participated in a Twitter chat led by a physician-educator from the United Kingdom. This Twitter chat (#ukmeded) is usually held on Thursdays at 9:00 pm UK time. This was a rich discussion on Twitter, and it also allowed me to participate in a discussion with people from other parts of the world. The most recent topic was on assessment (follow the link and learn more about the subtopics discussed).

One of the interesting questions discussed was: “Does assessment drive learning?”

Formative Assessment

According to the ACGME (2011), assessment is defined as an ongoing process of gathering and interpreting information about a learner’s knowledge, skills, and/or behavior. The ACGME also provides a document on the components of a formative evaluation for residents.

The importance of a formative assessment lies in its usefulness of helping learners and assessors to know where they are and what they need to do to improve. This type of assessment, when done impromptu and appropiately in the form of descriptive-feedback, must be timely, specific, and ideally correlative to the six competency domains. Assessments may also be spaced out at longer intervals, but even at these times it should also be specific as to what the learner’s performance level is and a description of how to improve.<

Formative assessment has also been used in other settings to evaluate and modify the teacher’s effectiveness by the adult learner. Improvement is also more effective when the assessor focuses on the task performance and not the learner’s ego.Dylan Wiliam, Ph.D. has researched formative assessment extensibly and describes two types of feedbacks:

  1. Ego-involving: Not useful to the learner
  2. Task-involving: Helpful to the learner

Summative Assessment

Summative assessments, when valid and reliable, are more appropriate to make high stakes decisions. Be aware that “data from the formative assessment should not be used to make high stakes decisions (promotion, graduation),” according to the ACGME. Benchmarks/standards are used to evaluate the learner, and it usually takes place at the end of the year. It is a good habit to be aware of what type of evaluation your residency program uses and its components so you know up to what standards you are being compared to. Adult learners for the most part are self-directed, self-evaluators, and should take a big part in the development of the curriculum where they can state what their needs are. This is a bit controversial due to the fact that evaluators who might be long removed from training lay out different curriculum needs than the adult learner’s.

Bottom Line

When using formative and summative assessments, like everything else in medical training, it is important to factor in and ensure patient safety. These tools also offer an opportunity for the learner to improve on his/her practice of medicine. So to answer the original question posed by Dr. Natalie Lafferty (@nlafferty) and Dr. Anne Marie Cunningham (@amcunningham), it is my belief that formative assessment drives learning, while summative assessment does not. Summative assessment is what institutions use to tell the world their assessment about the learner.

Formative assessment is FOR learning.
Summative assessment is OF learning.

To learn more, watch Dr. Carla Pugh’s above YouTube talk on “Advancing Healthcare Quality Through Formative and Summative Assessment”

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Javier Benitez, MD

Javier Benitez, MD

ALiEM Featured Contributor
Javier Benitez, MD


Medical doctor, tweets not medical advice or endorsements. Interested in #MedEd & technology. Always learning. I'm no expert. No financial conflict of interest.
Javier Benitez, MD