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Competency-based medical education (CBME) is being implemented worldwide. In CMBE, residency training is designed around competencies required for unsupervised practice and use entrustable professional activities (EPAs) as workplace "units of assessment". Well-designed workplace-based assessment (WBA) tools are required to document competence of trainees in authentic clinical environments. In this study, we developed a WBA instrument to assess residents' performance of intra-operative pathology consultations and conducted a validity investigation. The entrustment-aligned pathology assessment instrument for intra-operative consultations (EPA-IC) was developed through a national iterative consultation and used clinical supervisors to assess residents' performance at an anatomical pathology program. Psychometric analyses and focus groups were conducted to explore the sources of evidence using modern validity theory: content, response process, internal structure, relations to other variables, and consequences of assessment. The content was considered appropriate, the assessment was feasible and acceptable by residents and supervisors, and it had a positive educational impact by improving performance of intra-operative consultations and feedback to learners. The results had low reliability, which seemed to be related to assessment biases, and supervisors were reluctant to fully entrust trainees due to cultural issues. With CBME implementation, new workplace-based assessment tools are needed in pathology. In this study, we showcased the development of the first instrument for assessing resident's performance of a prototypical entrustable professional activity in pathology using modern education principles and validity theory., (© 2021. The Author(s).)

Theoretical and empirical support is increasing for mastery learning, in which learners must demonstrate a minimum level of proficiency before completing a given educational unit. Mastery learning approaches aim for uniform achievement of key objectives by allowing learning time to vary and as such are a course-level analogue to broader competency-based curricular strategies. Sound assessment is the cornerstone of mastery learning systems, yet the nature of assessment validity and justification for mastery learning differs in important ways from standard assessment models. Specific validity issues include (1) the need for careful definition of what is meant by "mastery" in terms of learners' achievement or readiness to proceed, the expected retention of mastery over time, and the completeness of content mastery required in a particular unit; (2) validity threats associated with increased retesting; (3) the need for reliability estimates that account for the specific measurement error at the mastery versus nonmastery cut score; and (4) changes in item- and test-level score variance over retesting, which complicate the analysis of evidence related to reliability, internal structure, and relationships to other variables. The positive and negative consequences for learners, educational systems, and patients resulting from the use of mastery learning assessments must be explored to determine whether a given mastery assessment and pass/fail cut score are valid and justified. In this article, the authors outline key considerations for the validation and justification of mastery learning assessments, with the goal of supporting insightful research and sound practice as the mastery model becomes more widespread.

Mastery learning is an instructional approach in which educational progress is based on demonstrated performance, not curricular time. Learners practice and retest repeatedly until they reach a designated mastery level; the final level of achievement is the same for all, although time to mastery may vary. Given the unique properties of mastery learning assessments, a thoughtful approach to establishing the performance levels and metrics that determine when a learner has demonstrated mastery is essential.Standard-setting procedures require modification when used for mastery learning settings in health care, particularly regarding the use of evidence-based performance data, the determination of appropriate benchmark or comparison groups, and consideration of patient safety consequences. Information about learner outcomes and past performance data of learners successful at the subsequent level of training can be more helpful than traditional information about test performance of past examinees. The marginally competent "borderline student" or "borderline group" referenced in traditional item-based and examinee-based procedures will generally need to be redefined in mastery settings. Patient safety considerations support conjunctive standards for key knowledge and skill subdomains and for items that have an impact on clinical outcomes. Finally, traditional psychometric indices used to evaluate the quality of standards do not necessarily reflect critical measurement properties of mastery assessments. Mastery learning and testing are essential to the achievement and assessment of entrustable professional activities and residency milestones. With careful attention, sound mastery standard-setting procedures can provide an essential step toward improving the effectiveness of health professions education, patient safety, and patient care.

Guidelines for reporting several types of medical studies have been described in the literature. However, there are no current guidelines to report studies on mastery learning curriculum development and trainee evaluation in medical education. Such guidelines will be important because medical education is moving toward a competency-based model. The authors sought to define standards for the evaluation of mastery learning curricula using previously published guidelines in related fields and expert review.The authors reviewed previously published guidelines from clinical medicine, medical education, and the social sciences. Six authors with expertise in mastery learning curricula, performance assessment, and medical education compiled and reached agreement about a list of guidelines. The authors later circulated the list to 12 other experts and made revisions. A final list of guidelines was established and received group consensus. The Reporting Mastery Education Research in Medicine (ReMERM) guidelines have 22 categories with 38 items considered to be imperative for reporting a mastery learning research study. Details about each item, with a specific focus on those unique to mastery learning, are discussed.The ReMERM guidelines highlight the importance of developing rigorous curricula that embody reliable measures which yield valid decisions about achievement among medical learners. These guidelines should improve the quality of reporting and help educators, authors, peer reviewers, journal editors, and readers to better understand and evaluate mastery learning research. With this shift to competency-based medical education, the ReMERM guidelines should help meet medical educators' needs to achieve these new goals.

Introduction: The physical examination is an essential clinical competence for all physicians. Most medical schools have students who learn the physical examination maneuvers using a head-to-toe approach. However, this promotes a rote approach to the physical exam, and it is not uncommon for students later on to fail to appreciate the meaning of abnormal findings and their contribution to the diagnostic reasoning process. The purpose of the project was to develop a model teaching session for the hypothesis-driven physical examination (HDPE) approach in which students could practice the physical examination in the context of diagnostic reasoning., Methods: We used an action research methodology to create this HDPE model by developing a teaching session, implementing it over 100 times with approximately 700 students, conducting internal reflection and external evaluations, and making adjustments as needed., Results: A model nine-step HDPE teaching session was developed, including: (1) orientation, (2) anticipation, (3) preparation, (4) role play, (5) discussion-1, (6) answers, (7) discussion-2, (8) demonstration and (9) reflection., Discussions and Conclusions: A structured model HDPE teaching session and tutor guide were developed into a workable instructional intervention. Faculty members are invited to teach the physical examination using this model.

Background: Establishing credible, defensible, and acceptable passing scores for performance-type examinations in real-world settings is a challenge for health professions educators. Our purpose in this article is to provide step-by-step instructions with worked examples for 5 absolute standard-setting methods that can be used to establish acceptable passing scores for performance examinations such as Objective Structured Clinical Examinations or standardized patient encounters., Summary: All standards reflect the subjective opinions of experts. In this "how-to" article, we demonstrate procedures for systematically capturing these expert opinions using 5 research-based methods (Angoff, Ebel, Hofstee, Borderline Group, and Contrasting Groups). We discuss issues relating to selection of judges, use of performance data, and decision-making processes., Conclusions: Different standard-setting methods produce different passing scores; there is no "gold standard." The key to defensible standards lies in the choice of credible judges and in the use of a systematic approach to collecting their judgments. Ultimately, all standards are policy decisions.