type of learning being tested, and the educational experiences that students receive should correlate with the ways in which the intended learning will be assessed (Friedman Ben-David, 1999). On the first of these, van der Vleuten (1996) identifies several parameters of utility – reliability, validity, educational impact, cost-effectiveness, and acceptability – that in any given assessment situation will be weighted differentially according to the purpose for which it is deployed. For example, in high stakes certification, the priority may be to maximise reliability, whereas in-training assessment designed to incorporate a suite of tools might instead accentuate educational impact (van der Vleuten, 1996). Given the inevitable trade-off between the five parameters, it then becomes especially important to combine a blend of relevant methods in a programme of assessment (van der Vleuten & Schuwirth, 2005).
Also, Schuwirth & van der Vleuten (2006) observe that, “the responsibility regularly falls to medical teachers to set up fair assessment systems”. For example, does the sampling of content to be tested correspond with the legitimate expectations of students in terms of what has been previously indicated to them? Are there parts of the course that have predictably been assessed over recent years, and which students may therefore also be anticipating for the test? Alternatively, will the assessment include material on which students may consider they have already been examined, and consequently not expect it to be covered?
What to assess and how to assess, then, are closely bound up with each other, and together have implications for course planning antecedently. Friedman Ben-David (2000) observes that, “One of the important principles of assessment is the match between assessment methods and the learning mode, the developmental level, the subject-matter and the programme outcomes”. As McAleer (2009) explains, “In selecting an assessment instrument it is necessary to know exactly what it is that is to be measured. This should reflect the course outcomes, i.e. what it is you want your students to be able to do. Different learning outcomes necessitate the use of different instruments. It is inappropriate to assess a performance skill with an MCQ”.
On the other hand, in law and ethics a multiple-choice question would be suitable where a single best answer can be framed in a set of realistic alternative responses, provided the potential number of realistic options is not high enough to confound the criteria for a single best answer (Schuwirth & van der Vleuten, 2009). Short-answer questions, requiring students to supply their own answer of up to a specified maximum length (such as one or two words), are suitable where there is a range of possible responses and it is an essential part of the task that the student constructs an answer without being presented with options, thereby ruling out a multiple-choice format. Staying with written assessments, the essay question is another open-ended format (again, meaning students construct their own answer), which is suitable where the task is to develop an elaborated response that goes beyond reproducing knowledge, such as in the assessment of ethico-legal reasoning, and requires more than only a few words (while again being within a specified maximum).
Other types of written question are characterised less by the nature of response required than they are by the format of the stimulus (Schuwirth & van der Vleuten, 2004). Context-free questions are suitable for testing
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Guide 53: Ethics and Law in the Medical Curriculum
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