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14-11-2018 | Original Article | Uitgave 6/2018 Open Access

Perspectives on Medical Education 6/2018

Validity evidence for programmatic assessment in competency-based education

Perspectives on Medical Education > Uitgave 6/2018
Harold G. J. Bok, Lubberta H. de Jong, Thomas O’Neill, Connor Maxey, Kent G. Hecker
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Editor’s Note:



Competency-based education (CBE) is now pervasive in health professions education. A foundational principle of CBE is to assess and identify the progression of competency development in students over time. It has been argued that a programmatic approach to assessment in CBE maximizes student learning. The aim of this study is to investigate if programmatic assessment, i. e., a system of assessment, can be used within a CBE framework to track progression of student learning within and across competencies over time.


Three workplace-based assessment methods were used to measure the same seven competency domains. We performed a retrospective quantitative analysis of 327,974 assessment data points from 16,575 completed assessment forms from 962 students over 124 weeks using both descriptive (visualization) and modelling (inferential) analyses. This included multilevel random coefficient modelling and generalizability theory.


Random coefficient modelling indicated that variance due to differences in inter-student performance was highest (40%). The reliability coefficients of scores from assessment methods ranged from 0.86 to 0.90. Method and competency variance components were in the small-to-moderate range.


The current validation evidence provides cause for optimism regarding the explicit development and implementation of a program of assessment within CBE. The majority of the variance in scores appears to be student-related and reliable, supporting the psychometric properties as well as both formative and summative score applications.
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