To the Editor, I read your editorial on “Evaluation tools in postgraduate medical education - Do we need “made in Oman” tools?”1 with interest and felt that the issue of formative versus summative assessment needed to be clarified before conclusions could be made about which and how assessment tools should be used. The terms “formative” and “summative” define the purpose of assessment and not the tools of that assessment. Formative assessment is used for diagnosis and remediation, while summative assessment is used for promotion and certification. The tools being used can be the same for both assessments; there are no tools that are specific for formative while others are for summative assessment. For example, an multiple choice question based test can be used in either a formative or a summative fashion. Ideally, all assessments should have a formative component even if used in a summative manner. The purpose of the formative component is to provide feedback to students on their strengths and weaknesses. The practice of using certain assessment methods for summative purposes stems from the reliability of the scores obtained from these methods; hence, their use in making important decisions about student progression as they alone can reliably ensure the fulfillment of the teaching mission of the medical school. Several very appealing assessment methods, especially in postgraduate medical education, are now emerging, but, despite their high face value, their cost effectiveness, educational impact, and use in undergraduate medical education needs to be carefully assessed before their use can be advocated. The resource intensity of these methods might very well be the factor that limits their use to very few medical schools as mentioned in your editorial. What one can advocate, however, is research into the evaluation of these assessment methods which is exactly what the document of “Assessment Policy, Regulations, & Guidelines” of the College of Medicine & Health Sciences at Sultan Qaboos University does.2 The policy not only affirms that assessment should be used in both formative and summative manner, but also goes further to recommend that assessment methods used should be evidence-based and, where evidence is lacking, best-practiced methods should be used and evaluated. Feedback, a major component of formative assessment, is also highlighted very well in this policy document which emphasizes that it should be given to students in a timely manner. The assessment tools listed in the policy document have, when used correctly, demonstrated validity and reliability. Tools such as checklists and rating scales are the basis of most workplace-based assessments such as the mini-clinical evaluation exercises, 360° assessment, direct observation of procedural skills, etc. can be used in any manner desired, formative or summative. Nadia Al Wardy Head, Medical Education Unit College of Medicine & Health Sciences Sultan Qaboos University Email: naiwardi@squ.edu.om SQU Med J, August 2010, Vol. 10, Iss. 2, pp. 280-281, Epub. 19th Jun 10 Submitted: - 18th Apr 10 أدوات التقييم للدراسة الطبية التخصصية هل حنتاج إىل أدوات “صنع يف ُعمان”؟ نادية الوردي Re: Evaluation Tools in Postgraduate Medical Education–Do we need “Made in Oman” tools? Nadia Al Wardy letter to editor Nadia Al Wardy Letter to Editor | 281 References 1. Lamki L, Lamki N. Evaluation Tools in Postgraduate Medical Education-Do we need “Made in Oman” tools? SQU Med J 2009; 9:219-23. 2. College of Medicine & Health Sciences, SQU Assessment Policy, Regulations, & Guidelines. 1st Ed. 2009. From http://www.squ.edu.om/medicine-health/tabid/1638/default.aspx Accessed April 2010. Authors’ Response We thank Dr. Al Wardy for her interest in our Editorial. The purpose of the Editorial was to stimulate discussion on the subject and we are glad it did, because this is a very important subject to all Medical Educationalists, undergraduate even more than postgraduate as pointed out by Dr. Al Wardy. We agree with Dr. Al Wardy that the terms summative and formative refer more to how the tool is used rather than the actual type of tool, but what we were pointing out in the Editorial is that some tools are intrinsically more formative than others. Indeed all tools can be used for both purposes. We also agree with Dr. Al Wardy that the summative purpose of the assessment tools in the “Assessment policy, Regulations, & Guidelines” of the College of Medicine & Health Sciences at Sultan Qaboos University stems from the reliability of these tools in ensuring the fulfillment of the teaching mission of the medical school – and hence our comment in the Editorial about those tools. We congratulate the College of Medicine & Health Sciences at Sultan Qaboos University for the two major steps forward they have taken recently in producing the new avant-garde curriculum and impressive set of assessment tools in the new “Assessment policy, Regulations, & Guidelines”. Congratulations to you and the Medical Education Unit, and keep up the great work. Lamk Al-Lamki Neela Al-Lamki Editor-in-Chief Co-Author SQU Medical Journal Oman Medical Specialty Board Email: mjournal @SQU.EDU.OM Email: n_lamki@yahoo.com