“Learner assessment” usually refers to assigning ratings and writing comments on forms at the end of a rotation. Although these are important aspects of assessment, assessment can begin the moment a preceptor meets a learner, and it can set the stage for a meaningful learning experience. Whether the time together is one half-day session or several weeks, preceptors who assess their learners’ competence, knowledge, and interests “in the moment” can help target their teaching to the learners’ goals and needs. This article, which is next in the series by the Council on Medical Student Education in Pediatrics about the skills of great clinical teachers, provides strategies for an "Assessment for Learning."

Assessment encompasses gathering data about a learner’s performance through observation and interactions, providing feedback, recording observations and ratings, and synthesizing data to make summary recommendations about a learner. Assessment for learning, sometimes called formative assessment, includes those aspects of assessment that shape the learner’s abilities.1  Clinical teachers are ideally suited to assess for learning in clinical work environments, beginning in the first moments when meeting a learner.2 

The benefits of assessing a learner’s knowledge, abilities, and goals at the beginning of a teaching interaction include the following:

  1. Preceptors are better able to teach to the learner’s level and help them progress.

  2. Preceptors are better equipped to help the learner address individual learning goals.

  3. Preceptors can help prepare an “educational sign out” or “teaching handover” that they, or the learner, give to the next preceptor to allow both the teacher to be prepared and the learner to continue their learning trajectory.3 

  4. Preceptors are better able to write high-quality, helpful narrative comments, facilitating future learner progress and assisting clerkship directors and grading committees in monitoring learners’ progress.4  When making some quick observations and assessments in the moment, a preceptor can use them in real time to teach but then also scribble a quick note. Then, when it comes time to complete an evaluation form, the preceptor can use the notes to provide specific examples in comments for summative assessment.

Course objectives and evaluation forms are a great place to begin the conversation about learning goals because they provide a framework and clear outline of expectations. Preceptors and trainees can devise a plan of which topics to focus on during the clinical experience. Inquiring about personal interests, career goals, and learning goals (eg, specific physical examination techniques, presentation skills, or clinical reasoning) can also help guide and individualize teaching while providing insight into the learner’s approach to self-assessment.

Although it may not be realistic to observe learners doing all their clinical work, observations can focus on parts of the history, specific physical examination skills, interacting with patients, sharing information with families, or coordinating with team members. Observations of even a few minutes will add insight about current performance and appropriate next steps.5,6 

While caring for patients together, preceptors can focus the learner on specific patient care goals by asking, “What is the most important thing we need to know about this patient to help us determine the best management plan?” (For some patients, it is the presence or absence of fever, results of blood tests, evolution of a rash, or need for oxygen.) The student’s reply can assist the preceptor in determining how the learner is approaching clinical reasoning for this patient.7  The preceptor can then adjust the conversation to the knowledge level of the trainee.

Another approach is “Learn Something New Every Day” rounds. All team members (students, residents, nurses, and preceptors) take turns sharing something they learned recently. For a large team, set a time limit of 60 seconds for each person’s “teaching pearl” to keep the discussion short. This strategy allows each team member to practice teaching and also provides an authentic opportunity to model and practice lifelong learning. In addition, this approach gives preceptors an opportunity to assess learners’ knowledge, communication skills, and motivation.

Reviewing clinical guidelines or protocols provides another method to both assess and teach in an outpatient clinic, hospital unit, or newborn nursery by encouraging learners to think aloud about why pediatricians do what they do. For example, in the newborn nursery, education about hypoglycemia guidelines can begin with asking learners questions such as, “Which infants are at risk for low blood glucose?"; "Why?"; "What is the pathophysiology?"; "How long would that risk last?” For hyperbilirubinemia guidelines, ask, “Which infants are at risk for jaundice?"; "When or how often do we measure their bilirubin?"; "At what point do we start phototherapy?” This strategy helps preceptors assess learners’ understanding of disease process, epidemiology, and rationale for evaluation and management and then guide teaching to the appropriate level for each topic.

Activities as straightforward as discussing a clinical case or an approach to a chief complaint (“2 month old with wheezing” or “15 year old with abdominal pain”) can also provide an opportunity to assess the learner’s knowledge and clinical reasoning while discussing the differential diagnosis, evaluation, and management plan. Learners can ask clarifying questions about the patient, and the teacher and learner can discuss the clinical reasoning of why different diagnoses may be higher or lower on the list depending on the answers.8 

The reporter, interpreter, manager, educator (RIME) framework provides a practical way to synthesize an assessment while working with a student.4,8  The RIME framework helps clinical teachers look for patterns in each learner’s competence in clinical care. A reliable reporter consistently and accurately gathers the data needed for patient care and presents it in a clear and organized way. An interpreter interprets what the information means for patient diagnosis and care. A manager consistently proposes, discusses, and implements treatment plans. An educator educates himself or herself, patients, or others about each patient’s diagnosis and care needs. The RIME framework helps preceptors summarize their observations about the learner’s abilities, identify the level in the framework at which the learner generally performs, and outline a plan for improvement.

Preceptors who have engaged in assessment for learning are well positioned to help learners create specific goals regarding physical examination or communication skills, interpretation of laboratory results, knowledge of clinical guidelines and how to apply them, or other aspects of clinical reasoning and care that have been observed, taught, and discussed. Preceptors can assist learners in self-assessing their own learning, articulating refined goals for their next clinical experience, defining specific feedback they can request from another teacher, and determining how they will decide whether they have succeeded in meeting their goals.

Assessment for learning, developed and practiced in observations and teaching in the clinical setting, forms a strong foundation for shaping a learner’s progress (Table 1). The same observations and guidance for learning form the basis for high-quality comments on evaluation forms, whether the teacher and learner spend a few hours or a few weeks working together. Specific examples of what the learner said and did while caring for patients benefit everyone: the teacher who assesses and guides, the learner who progresses and forms new goals, and the program leader who makes decisions about the learner’s readiness for the next steps along the path of education.

Drs Hanson and Bannister conceptualized the article and drafted the initial manuscript; Dr Wallace contributed important concepts to the article and edited the initial manuscript; and all authors reviewed and revised the manuscript, and approved the final manuscript as submitted, and agree to be accountable for all aspects of the work.

FUNDING: No external funding.

RIME

reporter, interpreter, manager, educator

1
Pangaro
LN
,
McGaghie
WC
, eds.
Handbook on Medical Student Evaluation and Assessment
.
North Syracuse, NY
:
Gegensatz Press
;
2015
2
Norcini
J
,
Burch
V
.
Workplace-based assessment as an educational tool: AMEE Guide No. 31
.
Med Teach
.
2007
;
29
(
9
):
855
871
3
Fuchs
J
,
King
M
,
Devon
EP
,
Guffey
D
,
Keeley
M
,
Rocha
MEM
.
Mitigating “Educational Groundhog Day” - the role of learner handoffs within clinical rotations: a survey of pediatric educational leaders [published online ahead of print August 22, 2019]
.
Acad Pediatr
. doi:
4
Holmes
AV
,
Peltier
CB
,
Hanson
JL
,
Lopreiato
JO
.
Writing medical student and resident performance evaluations: beyond “performed as expected”
.
Pediatrics
.
2014
;
133
(
5
):
766
768
5
Lane
JL
,
Gottlieb
RP
.
Structured clinical observations: a method to teach clinical skills with limited time and financial resources
.
Pediatrics
.
2000
;
105
(
4, pt 2
):
973
977
6
Hanson
JL
,
Bannister
SL
,
Clark
A
,
Raszka
WV
 Jr.
.
Oh, what you can see: the role of observation in medical student education
.
Pediatrics
.
2010
;
126
(
5
):
843
845
7
Stuart
E
,
Hanson
JL
,
Dudas
RA
.
The right stuff: priming students to focus on pertinent information during clinical encounters
.
Pediatrics
.
2019
;
144
(
1
):
e20191311
8
Dell
M
,
Lewin
L
,
Gigante
J
.
What’s the story? Expectations for oral case presentations
.
Pediatrics
.
2012
;
130
(
1
):
1
4

Competing Interests

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.