The Secret Life of Assessments: What Medical Students Think!

Blog post by Katherine Moreau, PhD

Ah, the world of medical school: long hours, lots of caffeine, and… assessments. For anyone who’s stepped into a white coat and faced the whirlwind of clinical rotations, you know assessments are part of the gig. But what do medical students think about all these assessments? Well, buckle up because we’re about to dive into the world of Daily Encounter Cards, Mini-CEXs, and OSCEs straight from the source: the students themselves!

What Are Clinical Assessments?

Before we get into the nitty-gritty, let’s take a moment to talk about what all these assessments are. During clinical rotations, medical students are assessed in various ways using tools such as:

• Daily Encounter Cards (DECs): A quick, everyday check-in.
• Mini-Clinical Exams (Mini-CEx): Think mini exams focusing on one clinical skill at a time.
• Objective Structured Clinical Exams (OSCEs): The big leagues. These involve multiple stations where students show off their clinical abilities.
• Multisource Feedback (MSF): Feedback from a variety of sources to give students a broader picture of their performance.
• Online Portfolios: A digital record of everything, from feedback to reflections.

Despite all the professional development clinical educators receive in giving effective feedback, little research has been done on how students feel about these assessments. So today, we are diving into what medical students think about these assessments and how they impact their education.

Three Big Takeaways from the Students

Interviews with students revealed three major themes.

1. Clinical Assessments = A Boost for Learning and Skills

Most students think clinical assessments are helpful in learning. Here’s why:

• Forming a Clinical Approach: Students say feedback helps them organize their thoughts and develop clinical problem-solving skills.
• Finding Strengths and Weaknesses: Regular assessments help pinpoint what they are doing well and where they need improvement.
• Daily Feedback = Instant Fixes: Daily encounter cards and mini-CExs give students real-time feedback, allowing them to adjust their approaches.
• Self-Study Motivation: Assessments are not just about getting grades. They often spark curiosity and self-study, especially when a preceptor points students toward areas they should read more about.

2. But… They Don’t Do Much for Licensing Exams (Except OSCEs)

Now, here’s where things get interesting. While assessments are helpful for learning, they don’t prepare students for licensing exams. The students in this study said only the OSCEs seemed to have any direct correlation with the licensing exams. But wait, there’s more! Here’s where the clinical assessments make a real difference:

• Residency Applications: The feedback from these assessments is not just filed away. It plays a role in residency applications. Many students’ comments from their preceptors are summarized in a document (the Medical Student Performance Record, or MSPR) and sent to residency programs. Those seemingly small comments can influence their chances of getting into a residency program.
• Reference Letters: Students use assessments and feedback to determine which preceptors are good reference letter writers for residency applications.

3. Clinical Assessments Have Pros and Cons

Let’s be honest: no system is perfect. Students quickly pointed out the ups and downs of the various clinical assessment tools they used.

The Pros:

• Fairness: They appreciate that the assessments are structured and give everyone a fair shot.
• Regular Feedback: A formalized system for regular feedback ensures students do not go months without knowing how they are doing.
• Peer Comparisons: Students like the assessments that let them see how they stack up against their peers.

The Cons:

• Inconsistent Feedback: Not all preceptors provide the same quality of feedback, and students often receive vague or generic comments that do not offer much to work with.
• Time Delays: Sometimes feedback comes too late to be useful for immediate improvement.
• Lack of Direct Observation: Students noted that assessments may miss key aspects of their clinical performance without direct observation.

The Hidden Impact of Clinical Assessments

Overall, clinical assessments shape medical students’ learning and clinical skills. They help students reflect on their performance and may guide their studies. However, there is room for improvement. Assessment should provide constructive feedback. There also needs to be consistency across different preceptors. Ultimately, clinical assessments do not just affect how students perform on their current rotations; they also influence their future careers.