Medical Education in South Africa: assessment practices in a developing country

This thesis addresses the topic of student assessment as it pertains to the training of medical practitioners in South Africa. The specific aspects of assessment that constitute the main focus of attention of this dissertation are: (1) the purpose of assessment, and (2) the utility of assessment. As will become clear from the literature overview, these two aspects of assessment are closely related, indeed intertwined. Assessment serves three fundamental purposes: (1) to measure student achievement in order to make decisions regarding selection, placement, promotion to the next year of study, graduation and certification, (2) to facilitate student learning and (3) to improve the quality of training programmes by initiating and sustaining curriculum change. While the measurement of student achievement is a widely recognised and extensively used function of assessment, the other important role, which is to improve the quality of education, is often neglected. This is not due to a lack of recognition of the educational impact of assessment on both student learning and curriculum development and change, but rather an overemphasis of one purpose at the expense of the others. In this thesis, the term “utility” is understood to mean the “perceived usefulness or fitness for purpose” of assessment processes. The key parameters that determine the utility of assessment tools can be clustered into two groups: (1) parameters indicating the rigour of assessment practices – more commonly referred to as the validity and reliability of assessment, and (2) parameters determining the practicality of assessment processes – usually thought of in terms of feasibility, acceptability and cost; i.e. financial, human and other resources required Advances in our understanding of both the purpose and utility of assessment have significantly improved medical education assessment practices over the past 30 years. The opening chapter of this thesis provides a broad overview of assessment practice advances specifically relevant to the work described in this dissertation. Four key assessment themes in the literature are reviewed: (1) the use of assessment to measure professional competence, (2) the use of assessment to facilitate student learning, (3) the use of assessment to initiate and sustain curriculum change, and (4) the selection of assessment tools on the basis of their utility (fitness for purpose). Most of the reviewed assessment practice advances have been implemented in, and have impacted upon, medical training programmes in developed regions of the world. Very little is known about assessment practices in resource-constrained settings typical of developing world regions. This thesis specifically focuses on advances in medical education practices, assessment in particular, implemented in medical training programmes in South Africa.

• View at Worldcat

Full Text ( Final Version , 588kb )