A Qualitative Study Of Formative Assessment Practices In An Internal Medicine Clerkship Course
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Accrediting bodies for medical schools require that medical students be provided with formative assessment in all clerkship courses. The literature describes many strategies for formative assessment in clerkship settings, but qualitative studies of clerk and supervisor experiences with formative assessment are lacking. In this thesis, I describe a study that explores clerk and supervisor experiences with formative assessment in one internal medicine clerkship course. First, the literature was reviewed to determine current conceptions of formative assessment and learning in medical education. Then, novice and experienced clerks were recruited to participate. Prior to starting their Core Internal Medicine course, each clerk participated in an interview to understand his or her concepts of learning and assessment. During the six-week course, they replied to an electronic weekly questionnaire to describe and reflect on learning experiences. Finally, they participated in a focus group at the end of the course, to explore their experiences with formative assessment. Supervisors, (residents and attending physicians), who supervised clerks were recruited to participate in one interview to explore their approach to supervision and assessment of clerks, and to understand factors that influenced their ability to do this. All relevant artifacts (forms, policies, procedures) were collected for subsequent analyses. Four experienced clerks and eleven novice clerks participated, along with eight attending physicians and five residents. Participants identified four key themes as playing a significant role in assessment and learning: (a) the developing role of doctor, (b) the role of the team, (c) working and learning environments, and (d) educational strategies. Data analysis revealed the participants had unclear formal concepts of formative assessment, even though they could all describe the key concepts about how assessment affects learning, and were quite clear about what factors supported learning, and which ones were barriers to learning. The study contributes to our understanding of clerks’ and supervisors’ experiences with assessment and learning in a workplace-based learning setting. Finally, the study led to recommendations about how to better support formative assessment in the Core Internal Medicine course, and for further research.