• S Beth Bierer, Elaine F Dannefer, Christine Taylor, Phillip Hall, and Alan L Hull.
• Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland 44195, USA. biererb@ccf.org
• Med Teach. 2008 Jan 1; 30 (7): e171-7.

BackgroundThe Cleveland Clinic Lerner College of Medicine was designed to encourage medical students to pursue careers as physician investigators. Our faculty decided that assessment should enhance learning and adopted only formative assessments to document student performance in relation to nine broad-based competencies. No grades are used to judge student performance throughout the 5-year program. Instead, assessments are competency-based, relate directly to performance standards, and are stored in e-Portfolios to track progress and document student achievement. The class size is limited to 32 students a year.AimsSchools with competency-based curricula must provide students with formative feedback to identify performance gaps and monitor progress. We describe a systematic approach to assess medical knowledge using essay-type questions (CAPPs) and multiple choice questions (SAQs) to provide medical students with weekly, formative feedback about their abilities to acquire, apply and integrate basic and clinical science concepts.MethodProcesses for developing performance standards, creating assessment items, training faculty, reporting student performance and monitoring outcomes are described. A case study of a Year 1 course is presented with specific examples of CAPPs and SAQs to illustrate how formative assessment data are interpreted and reported in students' e-Portfolios.ResultsPreliminary evidence suggests that CAPPs and SAQs have a positive impact on students' education, a justifiable cost in light of obtained benefits and growing acceptance among stakeholders. Two student cohorts performed significantly above the population mean on USMLE Step 1, which suggests that these assessment methods have not disadvantaged students. More evidence is needed to assess the reliability and validity of these tools for formative purposes.ConclusionsUsing assessment data for formative purposes may encourage application and integration of knowledge, help students identify performance gaps, foster student development of learning plans and promote student responsibility for learning. Discussion provides applications for institutions with larger classes to consider.

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