al. (1993). Campbell et al. (2007) also adapt Miller’s outcomes in ethico- legal assessment. Their structure places knowledge at the base, habituation immediately above (“the mould within which a student behaves”), and action at the apex region. They emphasise that all three levels are desirable in “an ideal of the ethical doctor”, and as a result all three need to be appropriately assessed.
Box 20 summarises the assessment methods recommended in each of these versions. The vocabulary broadly follows that of the authors, which is partly descriptive and does not always specify the methods intended, and different authors use different terms that will overlap in meaning. Actual exemplars and practical discussion of a range of assessment methods are available from the following sources. For ethics vignettes, see Beauchamp & Childress (2009); for ethics modified essay questions, see Mitchell et al. (1993); for discussion of a variety of written questions, see Schuwirth & van der Vleuten (2004, 2009); for a survey in assessment in medical law, see Preston-Shoot & McKimm (2010); for discussion of ethics clinical case reports, see Myser et al. (1995b); for full documentation of ethics OSCE stations, including instructions for students, marking criteria, and instructions for simulated patients, see the information in Singer et al. (1996); for discussion of OSCEs, see Marks and Humphrey-Murto (2009); for discussion of portfolios, see Davis & Ponnamperuma (2009); for discussion of e-portfolios, see the Higher Education Academy report (2008); for discussion of workplace-based assessment, see Davis et al. (2009); for discussion of 360° multisource feedback, see Berk (2009).
BOX 20
Matching assessment methods to levels derived from Miller’s outcomes Ramani & Leinster (2008)
Knowledge
Competence Performance Action
Wong & Cheung (2003) (after Mitchell, Myser & Kerridge)
Campbell, Chin & Voo (2007)
Know Can Do
Knowledge Habituation Action
Written exam
Clinical problem solving OSCE; clinical exam
Observation in clinical setting Case vignette; case report
OSCE
Portfolio; observation in clinical setting Essay & structured question; MCQ
Case report; portfolio OSCE; 360° multisource feedback
It is also important to ensure that medical law and not only medical ethics is assessed at each outcome level. This is not to say that medical schools should therefore deploy assessment methods that are specific to law schools. Test items for assessing clinical competencies should be as contextualised as possible, given that “retention is stimulated by a meaningful context, repetition and resemblance to the original situation” (Van der Vleuten, 1996). On this point, Friedman Ben-David (2000) comments that:
“Assessment methodology should focus on creating authentic environments, mainly at the latest stages of undergraduate education which assess multiple dimensions of performance as if they are carried out in real life. Compartmentalized assessment exercises such as in the OSCE are adequate for early stages of the undergraduate curriculum.”
It is also important to ensure that medical law and not only medical ethics is assessed at each outcome level. This is not to say that medical schools should therefore deploy assessment methods that are specific to law schools.
Guide 53: Ethics and Law in the Medical Curriculum
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