the corresponding component, but rather that they are potentially useful as partial sources of evidence. For convenience, Rest’s terminology is adapted here to vocabulary from the foregoing chapters of this AMEE Guide, correlating with awareness, analysis, valuing, and character.
BOX 19
Matching assessment methods to Rest’s four-component model (adapted) Awareness
Multiple-choice question, short-answer question, extended- matching question, modified-essay question, key-feature question, case report, project report, critical essay, reflective portfolio, OSCE, other clinical exam, observation in clinical setting, 360° multisource feedback
Analysis
Modified-essay question, key-feature question, case report, project report, critical essay, reflective portfolio, OSCE, other clinical exam, observation in clinical setting, 360° multisource feedback
Valuing Character
Project report, critical essay, reflective portfolio, OSCE, other clinical exam, observation in clinical setting, 360° multisource feedback
Observation in clinical setting, 360° multisource feedback
The problems associated with the three traditional constructs, theorising traits in the learner, led to the shift in medical education towards more observable competencies – the ability to perform a task successfully – aligned with the capabilities of a qualified practitioner (Schuwirth & van der Vleuten, 2006). This turn is reflected in the widely adopted taxonomy of outcomes articulated by Miller (1990) as a framework for clinical assessment in terms of a pyramidic hierarchy of knowledge (‘knows what’), competence (‘knows how’), performance (‘shows how’), and action (‘does’).
There are objections to focusing narrowly upon the observable in education. Barnett (1994) is critical of a one-dimensionally instrumental notion of ‘doing’ as operational knowledge. This is not to diminish the importance of the capacity to operationalise, especially in ethico-legal learning, where the level of action is of immediate relevance. The level of performance is different from this, however. Hodges (2006) sounds a warning against crudely subordinating knowledge to performance. Schuwirth & van der Vleuten (2004) affirm the importance of knowledge in medical competence. Others draw attention to the need to assess attitudes in ethics and law (Boon & Turner, 2004; Korszun et al., 2005; Whiting, 2007; Goldie, 2008). Further, Rees & Knight (2007) caution against both assessing the behavioural to the exclusion of the attitudinal and also “viewing individuals’ actions as representative of their underlying attitudes, and vice versa”. Similarly, Talbot (2004) describes the behaviourist approach as “a very blunt tool with which to fashion a proficient medical practitioner”. For assessment of ethics and law in medicine, then, the pyramid structure should not be interpreted as an ascending scale of importance but more like an iceberg of ethico-legal significance, with action constituting the emergent tip that breaks the surface.
Ramani & Leinster (2008) suggest relevant assessment methods for each of Miller’s outcomes. Wong & Cheung (2003) interact with the ‘know–can–do’ interpretation proposed by Norman (1991) and developed by Mitchell et
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Guide 53: Ethics and Law in the Medical Curriculum
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