233 International Journal of Human and Health Sciences Vol. 06 No. 03 July’22 Editorial: Continuous Assessment in Undergraduate Medical EducationTowards Objectivity and Standardization Salam A1, Yousuf R2, Allhiani RF3, Zainol J4 Keywords: Continuous assessment, Medical education, Objectivity, Standardization Correspondence to: Dr. Abdus Salam, Associate Professor and Head of Medical Education Unit and Community Medicine Unit, Faculty of Medicine, Widad University College, Bandar Indera Mahkota, 25200 Kuantan, Pahang, Malaysia. Email: abdussalam.dr@gmail.com ORCID iD: https://orcid. org/0000-0003-0266-9747 1. Abdus Salam, Medical Education Unit and Community Medicine Unit, Faculty of Medicine, Widad University College, Malaysia. 2. Rabeya Yousuf, Blood Bank Unit, Department of Diagnostic Laboratory Services, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia (UKM) Medical Centre, Malaysia. 3. Rajaa Fahad Allhiani, Medical Education Department, Faculty of Medicine, King Abdulaziz University, Saudi Arabia. 4. Jamaludin Zainol, Surgery Unit and Dean Faculty of Medicine, and Deputy Vice-Chancellor (Academic and Internationalisation), Widad University College, Malaysia. International Journal of Human and Health Sciences Vol. 06 No. 03 July’22 Page : 233-236 DOI: http://dx.doi.org/10.31344/ijhhs.v6i3.453 Assessment is an essential component of teaching- learning in higher education. It determines the extent of students’ learning or achievements over the course of study1. Teaching and assessment are the two sides of the same coin2. Teaching without testing is similar to cooking without tasting3. Educational testing or assessment thus drives learning, and learning ultimately drives practices4. Learning results in a change in learners’ behaviours5. Undergraduate medical education aims to produce doctors in the region who are safe, competent and confident and able to meet the health needs of the community while also being able to continuing medical education6. The medical curriculum is designed with specific content to meet societies’ demands by having competent medical doctors to offer quality medical care to their communities and clients worldwide7. In an effectively designed curriculum, course objectives reflect the assessment content8. The objectives fall into three domains: knowledge, skills, and attitudes. Knowledge objectives address cognitive measures ranging from being able to recall factual events to integrating processes for problem-solving and creation. Skills objectives involve psychomotor aspects needed to be an efficient clinician. Attitude objectives relate to the personal qualities of the learner and their approach to medicine, patients and their peers8. Knowledge is assessed by written examinations such as multiple-choice questions (MCQ), modified essay questions (MEQ), short answer questions (SAQ), and key feature questions (KFQ). The MCQs can be multiple true-false (MTF), single best answer (SBA) and extended matching questions (EMQ)9. The MCQs are the most widely used objective test items and can test any higher level of the cognitive domain if they are constructed well10. The practical skills are assessed by objective structured practical examination (OSPE). Clinical skills are assessed by clinical examination using the long case, short case and objective structured clinical examination (OSCE)9. Attitudinal aspects are assessed through the personal qualities and behavioural approach of the learners.This paper describes methods of continuous assessment used in undergraduate medical education aimed to ensure the objectivity and standardization of the assessment. It has been found that lack of objectivity and varying standards of assessment methods in higher education is a big problem11. Traditionally, the assessment system of students in educational institutions is one-shot, i.e., at the end of the International Journal of Human and Health Sciences Vol. 06 No. 03 July’22 234 course or semester or programme, which has strong criticism that it may not give much reliable information about students’outcomes. As a result, continuous assessment is introduced to harvest more reliable outcomes on students’ grades or learning12. Continuous assessments are a series of tests on students conducted during a course of study rather than a one-shot examination at the end of the term or semester. There is a continuous record of all academic achievements and activities in the various folders. The final mark or score of continuous assessment is the average of the scores achieved by the student and used to grade the students’ ability in that particular course.The marks are carried to the summative assessment, making summative assessments cumulative9. Continuous assessment guides the students and allows the teachers and counsellors in an educational institution to know the easiest way of assessing students without waiting for a one- shot assessment of traditional examination12.The continuous assessment appears to be an essential tool to monitor, guide and strengthen the course or the programme13. Continuous assessment worked for both formative and summative purposes14. It is formative, or “assessment for learning”, when used to diagnose students’ understanding and learning problems, provide appropriate feedback, and enable students to attain and improve meaningful learning. It is summative, or “assessment of learning”, when a mark is given that contributes to the complete results of the course /semester /programme to facilitate progression or certification15,16. Thus, the formative function facilitates students’ learning development, and the summative function enables progression and certification17. However, in supporting “assessment for learning,” the practice of formative feedback often faces challenges and seems to fail17. The reasons are widespread uses of continuous assessment with summative purpose18, the move towards modularization of curricula leading to an increase use of summative with a decreased use of formative assessment19, inadequate staff, growing student diversity, plagiarism17, lack of feedback, large class size, shortage of time, lack of facilities13 and inefficient staff. Feedback dialogue between student and faculty is an essential condition for students to have meaningful and constructive learning experiences17,20 and thereby improve the in-depth- learning and future studying as well21. However, it is evidenced that, the feedback given is not enough (quantity), is very brief, which may not be very helpful, or feedback does not provide advice on how to improve (quality), and feedback comes too late in regards to timing17. More feedback conversation between faculties and students is required so that students become aware of how the feedback can positively guide their learning17. Widespread use of continuous assessment with a summative function may cause the faculties to experience a heavy workload, especially in a large class with a lack of adequate teaching materials and institutional resources14. Students also may feel overloaded and will get less time for preparation for the subsequent assessment, which may them lead to cheating and plagiarism14. Moreover, faculties in medical schools in many cases traditionally are not trained to teaching and assessment3,22,23. Right now, the roles of faculties are changing from deliverer of material to a more creative, designer and facilitator of learning3. It is essential to train the faculty to develop their teaching skills and abilities in continuous assessment, giving constructive and effective feedback on pedagogical approaches and their effectiveness in delivering subject content within programmes14,24. Institutional support is mandatory to provide a conducive environment for its implementation, for faculty development and also to appreciate their contribution through rewards and incentives. The continuous assessment may include assessment of daily classwork, seminars, case presentation, course-related research project preparation, presentations and report writings, field visits with reporting, practical work etc. Mini clinical evaluation exercises (MiniCEX), direct observation of procedural skills (DOPS), objective structured long case examination records (OSLER), logbook and portfolio assessments are formative assessments often carried out for the clinical students9,25. A portfolio assessment system is an efficient tool for the students to concentrate their efforts. The portfolio also includes evidence of work, a logbook, personal reflections and certificates from the tutor on the students’ work26. Multi-source feedback (MSF) is another evaluation method for clinical students, consists of evaluation completed by peers, other clinical team members such as nurses, pharmacists, psychologists or even by patients on the trainees’ work habits, teamwork 235 International Journal of Human and Health Sciences Vol. 06 No. 03 July’22 capability, interpersonal sensitivity, etc. Examples of MSF tools include: Physician Achievement Review (PAR), 360-degree assessments or MINI- PAT (Peer Assessment Tool)27. It is essential that the assessment methods should be aligned to teaching and intended learning outcomes as well as valid, reliable and implemented for maximal effects14. Therefore, harmony between the assessment weightage and the curriculum towards objectivity and standardization is essential28. Assessment that aligns with the curriculum signifies its reliability and validity. Reliability is how an assessment gives a consistent outcome on a students’ progress across multiple measures. Validity is the extent to which an assessment measures what it is intended to measure29. Faculty development activity should be an integral part of educational institution for a sustainable educational and organizational development30. In conclusion, continuous assessments are a series of tests of students’ learning activities recorded continuously during the course period, which helps in students’ guidance by the teachers and the counsellors for educational development. Continuous assessment worked both for formative and summative purposes. But, formative purposes i.e., feedback delivery is failed due to inadequate staff, widespread uses of continuous assessment for summative purposes experiencing heavy faculty workload with lack of teaching materials, growing student diversity with plagiarism. Careful planning and well coordination between teaching delivery and assessment in terms of reliability and validity is recommended. The educational planners need to pay attention on the methods of continuous assessment towards objectivity and standardization through a harmony between weightage in the assessment system and the curricular content.Regular faculty development programmes should be implemented by well- trained trainer across all levels of faculty aimed to produce competent and confident human capitals for a sustainable educational and organizational development. Institutional management support with adequate resources is mandatory to provide a conducive environment for its implementation and also to appreciate the contribution through rewards and incentives. This paper offers a window for educators around the world to ensure the methods of continuous assessment toward objectivity and standardization in medical education. Funding No funding was received for this paper. Conflict of Interest The author declared no conflicts of interest. Authors’ Contribution All authors participated well in the preparation of this paper and approved the final version for submission to the Journal for publication. References: 1. Ferris H, Flynn DO. Assessment in Medical Education; What Are We Trying to Achieve? International Journal of Higher Education 2015; 4(2): 139-144. 2. Salam A. Best teaching method used, very good in teaching, the best lecturer ever: secrets of teaching online during COVID-19 pandemic. International Journal of Human and Health Sciences October 2021; 05(04): 377-380 DOI: http://dx.doi.org/10.31344/ ijhhs.v5i4.346 3. Zainol J and Salam A. An Audit on Mentor- Mentee Program: Mentees Perceptions on Mentors. Bangladesh Journal of Medical Science October 2021; 20(04): 840-847 DOI: https://doi.org/10.3329/ bjms.v20i4.54143 4. Yousuf R, Salam A. Teaching medical education during the era of COVID-19 pandemic: challenges and probable solutions. Bangladesh Journal of Medical Science 2021; 20(Special Issue): S3-S6. DOI: https://doi.org/10.3329/bjms.v20i5.55394 5. Salam A. TEA to Entertain Outcome Based Education for 21st Century Educators to Produce Safe Human Capitals for a Sustainable Global Development. International Journal of Human and Health Sciences 2022a; 06(02): 153-154 DOI:http://dx.doi. org/10.31344/ijhhs.v6i2.437 6. Salam A, Zainuddin Z, Latiff AA, Ng SP, Soelaiman IN, Mohamad N, Moktar N.Assessment of Medical Graduates Competencies. Annals Academy of Medicine 2008;37(9):814-816. 7. Asani M. Assessment methods in undergraduate medical schools. Nigerian Journal of Basic and International Journal of Human and Health Sciences Vol. 06 No. 03 July’22 236 Clinical Sciences 2012; 9(2); 53-60 8. Vergis A, Hardy K. Principles of Assessment: A Primer for Medical Educators in the Clinical Years. The Internet Journal of Medical Education 2009; 1 (1): 1-9. 9. Ahmed SS, Reddy SC. Assessment Tools Preferred by the Undergraduate Clinical Medical Students: A Study in National Défense University of Malaysia. European Journal of Clinical Medicine 2021;2(4): 14-19. 10. Salam A, Yousuf R, Bakar SMA. Multiple Choice Questions in Medical Education: How to Construct High Quality Questions. International Journal of Human and Health Sciences April 2020; 04(02):79- 88 DOI: http://dx.doi.org/10.31344/ijhhs.v4i2.180 11. Salam A, Y. Surahaya Mohd Yusof, Zainol J. Management of Teaching-learning in Classroom Setting. Journal of Science and Management Research 2022b; 9(1): 126-136. 12. Joy SC Obi, Susana U. Obineli. Continuous Assessment in Counselling. Hugotez Publications 2019. 13. Kugamoorthy S, Weerakoon WMS. Continuous assessment methods: critical review for quality improvement of the post graduate diploma in education programme of the open university of Sri Lanka. International Research Journal of Human Resources and Social Sciences 2018; 5(10): 55-71. 14. Vahed A, Walters MM, Ross AHA. Continuous assessment fit for purpose? Analysing the experiences of academics from a South African university of technology, Education Inquiry 2021; DOI: 10.1080/20004508.2021.1994687 15. Heywood J. Assessment in higher education. 2000. London: Jessica Kingsley 16. Knight PT and Yorke M. Assessment, learning and employability. 2003. Maidenhead: SRHE and Open University Press. 17. Herna´ndez R. Does continuous assessment in higher education support student learning? High Education 2012; 64:489-502. DOI: 10.1007/s10734-012-9506- 7. 18. McDowell L, Sambell K, Bazin V, Penlington R, Wakelin D, Wickes H, et al. Assessment for learning: Current practice exemplars from the centre for excellence in teaching and learning, guides for staff. 2005. Newcastle: University of Northumbria at Newcastle. 19. Yorke M. Formative assessment in higher education: Moves towards theory and the enhancement of pedagogic practice. Higher Education 2003;45:477- 501. 20. Reimann N, and Sadler I.Personal understanding of assessment and the link to assessment practice: The perspectives of higher education staff. Assessment and Evaluation in Higher Education 2017; 42(5): 724-736. 21. Turner J, and Briggs G.To see or not to see? Comparing the effectiveness of examinations and end of module assessments in online distance learning. Assessment and Evaluation in Higher Education 2018; 43(7): 1048-1060. 22. Salam A, Mohamad M. Teachers Perception on What Makes Teaching Excellence: Impact of Faculty Development Programme. International Medical Journal 2020;27(1):1-4. 23. Cater OT, Mann K, McCrorie, Ponzer S, Snell L, Steinert Y. Faculty development through international exchange: the IMEX initiative. Medical Teacher 2014; 36(7): 591-595.https://doi.org/10.3109/01421 59X.2014.899685 24. Amador F, Martinho AP, Bacelar-Nicolau P, Caeiro S, Oliveira CP. Education for sustainable development in higher education: Evaluating coherence between theory and praxis. Assessment and Evaluation in Higher Education 2015; 40(6):867–882. 25. Campbell C, Crebbin W, Hickey K, Stokes ML, Watters D. Work-based assessment: a practical guide. Building an assessment system around work. The Tripartite Alliance (RACP; RACS; RCPSC) 2014; p 1-31. 26. Haldane T. “Portfolios” as a method of assessment in medical education. Gastroenterol Hepatol Bed Bench 2014;7(2):89-93. 27. Sood R, Singh T. Assessment in medical education: Evolving perspectives and contemporary trends. The National Medical Journal of India 2012;25 (6): 357- 364. 28. Thomé G, Hovenberg H, Edgren G. Portfolio as a method for continuous assessment in an undergraduate health education programme.Medical Teacher 2006;28(6):e171-6. 29. Harris A.Editorial: Fit for purpose: Lessons in assessment and learning. English in Education 2017; 51(1): 5–11. 30. Salam A, Mohamad N, Siraj HH, Kamarudin MR, Yaman MN, Bujang SM. Team-based learning in a medical centre in Malaysia: Perspectives of the faculty. The National Medical Journal of India2014; 27(6): 350.