Medical Education

The Assessment Framework Redesign

To ensure our graduates are prepared to be exceptional clinicians, educators, and leaders, The Warren Alpert Medical School has launched a comprehensive Assessment Framework Redesign.

The Assessment Framework Redesign

To ensure our graduates are prepared to be exceptional clinicians, educators, and leaders, The Warren Alpert Medical School has launched a comprehensive Assessment Framework Redesign.

Running in parallel with our 2023 Curriculum Redesign, this new framework strengthens the alignment between our educational goals and the reality of residency readiness. It is a shift from ambiguity to actionable data, ensuring that every assessment meaningfully informs learner growth.

A Vision for Impact: A Message from Dean Hampton

https://www.youtube.com/embed/-6wetm-hE4A

Why the Framework is Changing

 

Learn more about how the new Assessment Framework Redesign aligns our educational goals and the reality of residency readiness.

Our ultimate goal is to increase our impact on patient care, on the medical field, and on future generations. To achieve this impact, we must first achieve clarity.

This competency-based framework delivers that clarity through three essential pillars: This competency-based framework delivers that clarity through three essential pillars:

  • Intentionality: We are moving beyond general impressions. Every assessment has a clear purpose, mapping directly to specific skills required for each learner experience.
  • Fairness: When expectations are precise, assessments become equitable. Students understand what is expected of them, allowing them to track their progress with care.
  • Growth: This competency framework allows students and faculty to map learning over time.

The New Assessment Framework: What to Expect

The new Assessment Framework represents a strategic shift designed to align our educational standards with the realities of graduate medical education. We have reorganized the traditional "Nine Abilities" into a nationally recognized competency framework based on the ACGME core competencies and UME Foundational Competencies. This structural change ensures that our language and expectations mirror those used in residency, facilitating a smoother transition for our students as they progress through the UME-GME continuum.

Under this new model, student development is tracked across six primary domains: Interpersonal & Communication Skills, Professionalism, Medical Knowledge, Practice-based Learning & Improvement, Systems-based Practice, and Patient Care. Each competency is further divided into specific "sub-competencies" that define the discrete behaviors, knowledge, and attributes required for proficiency. This granular approach allows us to assess performance based on observable, criterion-referenced behaviors rather than norm-referenced comparisons.

A central feature of this redesign is the adoption of the Dreyfus Model of skill acquisition to replace our previous rating scale. Instead of a deficit-based model, this framework emphasizes a growth mindset, tracking learners through learning stages across the medical school curriculum. This "roadmap for growth" helps mitigate bias by providing clear, standardized descriptions of what performance looks like at each level, ensuring that assessments are fair, transparent, and focused on continuous improvement.

https://www.youtube.com/embed/khV5TWvwFEk

Framework Basics

 

Learn more about how the new Framework aligns with ACGME core competencies.

Core Competencies and Sub-Compentencies

The Assessment Framework is designed to support our shared goal of preparing students for a successful transition to residency. By moving from the "Nine Abilities" to the ACGME core competencies, we are aligning with national standards and the language used in graduate medical education. This shift allows us to adopt a growth-oriented approach using the Dreyfus Model to better track student progress. Ultimately, these changes aim to mitigate bias and ensure fairness by providing you with clear, observable behaviors to guide your assessments.

The listed competencies mirror the residency competencies within the Accreditation Council for Graduate Medical Education. The competencies and sub-competencies are listed below. 

The Framework in Practice: What's Changing and What's Not

What's Changing

  • Course directors will use the assessment framework to define and refine overall course objectives, ensuring that they are clearly aligned with the core competencies and learner expectations.
  • Course directors will ensure that individual lectures, group sessions, and learning activities intentionally support those objectives, creating a coherent learning progression for each block.
  • Lecturers and small group leaders will be supported in articulating clear objectives for their sessions that help students understand what they are expected to learn and demonstrate. 

What's Not

  • Faculty maintain full ownership of content expertise, teaching style, and instructional approach.
  • Faculty are not expected to change what they teach. Instead, they are expected to clarify objectives and alignment with course outcomes and assessment methods towards course goals.
  • The framework does not prescribe a single pedagogical model. Instead, it is a shared structure and common language that supports rigorous and intentional instruction and assessment.

What's Changing

  • Preceptors are rating at the sub-competency level rather than the competency level.
  • The scale is now consistent across clerkships.
  • Tools can be student-assigned via QR code or administratively-assigned through email / OASIS login.
  • Learning experience-specific tools may be formative or summative. 

What's Not

  • Preceptors maintain a key role in shaping the students' learning.
  • The medical school is still utilizing OASIS as the rating platform.
  • Preceptors have to complete assessments within the specified timeframe.
  • Preceptors provide qualitative and quantitative assessments. 
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The Clinical Setting

 

How the new Assessment Framework will work in clinical settings.

Rating Scale

Our medical school utilizes a centralized performance scale across all clerkships to ensure consistency and clarity in student assessment. As illustrated in the scale below, ratings reflect a learner’s progression toward greater independence—from requiring frequent guidance to performing clinical tasks with increasing efficiency and initiative. Higher ratings indicate a greater ability to carry out sub-competencies with minimal prompting and appropriate clinical judgment.

Rating scale showing medical student progression from requiring frequent guidance to independence

While preceptors can view the full continuum of performance levels, the “Expected Performance for Sub-Intern Level” represents a standard beyond the scope of clerkship training and, therefore, is not selectable for clerkship students. This structure maintains high expectations while aligning evaluations with the developmental stage appropriate for each learner.

  • Below minimum performance for clerkship level
    Collects parts of required information but misses key elements unless prompted and frequent redirection to complete the task.
  • Progressing to clerkship level 
    Completes components of the task with guidance and recognizes obvious gaps when prompted.
  • Expected performance for clerkship level
    Performs the task appropriately for the clinical scenario with supervision, incorporating feedback to improve accuracy and completeness
  • Progressing to sub-intern level (Honors)
    Performs the task with minimal prompting, demonstrates increasing efficiency and prioritization, and occasionally initiates next steps with confirmation from supervisor/s
  • Expected performance for sub-intern level
    Independently performs the task accurately and efficiently for the clinical scenario, anticipates next steps, and requires minimal oversight consistent with a learner nearing internship.

Recommended Assessment Routine

This assessment routine is designed to promote intentional observation, meaningful dialogue, and timely feedback throughout the clinical experience. Preceptors are encouraged to begin with a brief check-in to clarify the student’s learning goals at the sub-competency level and confirm expectations for evaluation. This initial conversation establishes shared understanding and allows the experience to be tailored to the learner’s needs. During the clinical encounter, faculty should directly observe performance and assess students based on specific, firsthand observations. Finally, whenever possible, preceptors should provide prompt, constructive feedback that reinforces strengths and offers clear, actionable guidance for improvement. Consistent check-ins and timely feedback are essential to fostering growth, supporting progressive independence, and ensuring accurate, developmentally appropriate assessment.

  1. Check in with the Student
    Before the clinical experience, ask the students what their learning goals are at the subcompentency level and if you are expected to fill out at assessement form
  2. Observe
    Take mental notes of the student's performance within the experience. What did they do well? What can they improve upon?
  3. Check Form Details
    When you receive your form, please make sure that your name, students name, and assessment form matches.
  4. Assess
    Read each statement and rate the student based on what you have directly observed during the appropriate clinical experience.
  5. Provide Feedback
    If possible, provide quick, verbal feedback to the student based on your assessment and offer advice for improvement.
     

Resources for Course Leaders and Lecturers

The sections below offer practical guidance, shared tools, and points of support to help course leaders navigate implementation collaboratively and ensure a cohesive experience for both faculty and students. 
 

For Course Leaders

Successful course leaders:

  • Collaborate with curriculum deans to identify core content themes, learning objectives based on the medical education program objectives, and a reasonable sequence for the course.
  • Guide faculty in identifying relevant content that corresponds with their expertise or area of focus and the role of their course/course content in driving learning in that phase of curriculum.
  • Collect assessment questions from faculty and select questions that will be included in the exam.
  • Observe a number of lectures in order to provide lecturer feedback and identify fair assessment questions.
  • 5 to 6 months before
    • Preliminary schedule sent to course leaders
    • Review and recruit faculty
  • 4 to 5 months before
    • Meet with the Office of Medical Education to solidify schedule
    • Inform faculty of the schedule
    • Advise faculty on any lecture modifications
    • Request new exam questions
  • 1 month prior
    • Check-in with faculty
    • Review materials if needed
    • Meet with small group leaders if needed
  • During the course
    • Collect exam questions and modify as needed
  • 2 weeks before exam
    • Assemble exam
  • 1 month after the course ends
    • Review course evaluations with faculty and provide advice for future improvement
  • Faculty rely on your leadership to determine what topics would be most important for their lectures. To fully enjoy the teaching experience, they need guidance for what students need to know and what pedagogy works well. Please feel free to forward the lecturer guide provided to you.
  • Finally, if you are asking faculty to submit assessment questions, it is important to give them time and guidance for writing or finding appropriate questions. The NBME item- writing guide is an excellent resource. For the medical school, the best type of question is:
    • One-Best-Answer - Vignette followed by a series of choices, with one correct answer and anywhere from three to seven distractors.
  • Writing clear learning objectives that are tied to assessments.
     

Small group faculty play a critical role in shaping how students experience medicine in the pre-clerkship phase. As a course leader, your guidance helps ensure that small group teaching is aligned with overall course objectives that are grounded in the Assessment Framework, while honoring faculty expertise and unique facilitation styles.

Set Clear Expectations Early

Begin each course cycle by clearly communicating expectations including:

  • The purpose of small group sessions within the overall course design.
  • Which core competencies are emphasized in small group learning.
  • What they are expected to observe and assess.
  • How to provide feedback using this assessment framework.

Anchor Feedback in Observable Behaviors

  • Preparation?
  • Engagement?
  • Communication and Teamwork?
  • Clinical reasoning?
  • Professionalism and reflectiveness?

Make Assessments Manageable

Acknowledge the time and cognitive demands placed on small group faculty and make assessments manageable by:

  • Clearly identifying which sessions require formative and summative assessments.
  • Remind faculty that they are not expected to assess every competency in every session.
  • Encouraging timely, focused feedback that learners can utilize immediately. 
     

Create Space for Questions and Calibration

Because this is a new initiative, it is important to create scheduled communication channels to calibrate their teaching experience and learner expectations. These can include:

  • Check-ins (Beginning, Mid-Year, End-Year)
  • Orientation sessions or written overviews. 

For Lecturers

Highly-rated lecturers should: 

  • Have objectives that clearly helps the learner distinguish high-yield content from "nice-to-know" information.
  • Organize lecture slides based on the lecture objectives.
  • Have a slide that outlines topics for students.
  • Include practice questions that help consolidate what's been learned and reinforce important points.

Lecturers often want to know immediately if the learners understood the lecture. Assessments, in the form of practice questions are
fantastic in determining learned content and misconceptions that need to be addressed. For example, "Describe the three pathways of
metabolism." is better than "Learn alcohol metabolism." because it is clear, specific, and easily tied to assessment questions.

A good study guide includes the following components:

  • Learning objectives
  • Key terms and definitions
  • High-yield content summaries (tables, charts, etc. to emphasize mechanisms of disease or relationships between anatomy,
    physiology, and pathology.)
  • Clinical correlations (vignettes)
  • Practice questions and self-assessments
  • Visual aids
  • Common misconceptions