Cees van der Vleuten

Assessing professional competence: from methods to programmes

Introduction  We use a utility model to illustrate that, firstly, selecting an assessment method involves context‐dependent compromises, and secondly, that assessment is not a measurement problem but an instructional design problem, comprising educational, implementation and resource aspects. In the model, assessment characteristics are differently weighted depending on the purpose and context of the assessment.

Problem-based learning: future challenges for educational practice and research.

Context  Problem‐based learning (PBL) is widely used in higher education. There is evidence available that students and faculty are highly satisfied with PBL. Nevertheless, in educational practice problems are often encountered, such as tutors who are too directive, problems that are too well‐structured, and dysfunctional tutorial groups.

Portfolios in medical education: why do they meet with mixed success? A systematic review

Context  The move towards competence‐based medical education has created a need for instruments that support and assess competence development. Portfolios seem suitable but mixed reports of their success are emerging.

Conditions for successful reflective use of portfolios in undergraduate medical education

Aim  Portfolios are often used as an instrument with which to stimulate students to reflect on their experiences. Research has shown that working with portfolios does not automatically stimulate reflection. In this study we addressed the question: What are the conditions for successful reflective use of portfolios in undergraduate medical education?

Does problem‐based learning lead to deficiencies in basic science knowledge? An empirical case on anatomy

Introduction  Problem‐based learning (PBL) is supposed to enhance the integration of basic and clinical sciences. In a non‐integrative curriculum, these disciplines are generally taught in separate courses. Problem‐based learning students perceive deficiencies in their knowledge of basic sciences, particularly in important areas such as anatomy. Outcome studies on PBL show controversial results, sometimes indicating that medical students at PBL schools have less knowledge of basic sciences than do their colleagues at more traditional medical schools. We aimed to identify differences between PBL and non‐PBL students in perceived and actual levels of knowledge of anatomy.

Development of an instrument for measuring different types of cognitive load

According to cognitive load theory, instructions can impose three types of cognitive load on the learner: intrinsic load, extraneous load, and germane load. Proper measurement of the different types of cognitive load can help us understand why the effectiveness and efficiency of learning environments may differ as a function of instructional formats and learner characteristics. In this article, we present a ten-item instrument for the measurement of the three types of cognitive load. Principal component analysis on data from a lecture in statistics for PhD students (n = 56) in psychology and health sciences revealed a three-component solution, consistent with the types of load that the different items were intended to measure. This solution was confirmed by a confirmatory factor analysis of data from three lectures in statistics for different cohorts of bachelor students in the social and health sciences (ns = 171, 136, and 148), and received further support from a randomized experiment with university freshmen in the health sciences (n = 58).

Reflection: a link between receiving and using assessment feedback.

Problem statement and background Feedback is essential to learning and practice improvement, yet challenging both to provide and receive. The purpose of this paper was to explore reflective processes which physicians described as they considered their assessment feedback and the perceived utility of that reflective process. Methods This is a qualitative study using principles of grounded theory. We conducted interviews with 28 family physicians participating in a multi-source feedback program and receiving scores across the spectrum from high to low. Results Feedback, especially negative feedback, evoked reflective responses. Reflection seemed to be the process through which feedback was or was not assimilated and appeared integral to decisions to accept and use the feedback. Facilitated reflection upon feedback was viewed as a positive influence for assimilation and acceptance. Conclusions Receiving feedback inconsistent with self-perceptions stimulated physicians’ reflective processes. The process of reflection appeared instrumental to feedback acceptance and use, suggesting that reflection may be an important educational focus in the formative assessment and feedback process.

Students' opinions about their preparation for clinical practice.

Introduction  There are data that suggest that medical students do not feel sufficiently prepared for clinical practice in the clerkships. The transition from pre‐clinical to clinical training causes problems.

Solving problems with group work in problem-based learning: hold on to the philosophy.

Problem‐based learning (PBL) has gained a foothold within many schools in higher education as a response to the problems faced within traditional education.

The processes and dimensions of informed self-assessment: a conceptual model.

Purpose To determine how learners and physicians engaged in various structured interventions to inform self-assessment, how they perceived and used self-assessment in clinical learning and practice, and the components and processes comprising informed self-assessment and factors that influence these. Method This was a qualitative study guided by principles of grounded theory. Using purposive sampling, eight programs were selected in Canada, the United States, the United Kingdom, the Netherlands, and Belgium, representing low, medium, and high degrees of structure/rigor in self-assessment activities. In 2008, 17 focus groups were conducted with 134 participants (53 undergraduate learners, 32 postgraduate learners, 49 physicians). Focus-group transcripts were analyzed interactively and iteratively by the research team to identify themes and compare and confirm findings. Results Informed self-assessment appeared as a flexible, dynamic process of accessing, interpreting, and responding to varied external and internal data. It was characterized by multiple tensions arising from complex interactions among competing internal and external data and multiple influencing conditions. The complex process was evident across the continuum of medical education and practice. A conceptual model of informed self-assessment emerged. Conclusions Central challenges to informing self-assessment are the dynamic interrelationships and underlying tensions among the components comprising self-assessment. Realizing this increases understanding of why self-assessment accuracy seems frequently unreliable. Findings suggest the need for attention to the varied influencing conditions and inherent tensions to progress in understanding self-assessment, how it is informed, and its role in self-directed learning and professional self-regulation. Informed self-assessment is a multidimensional, complex construct requiring further research.