Priya Khanna 

Limitations of positivist nature of traditional assessment system in capturing the nuances of clinical competence has led to the uprising popularity of programmatic assessment as an alternate approach that embraces subjectivity of human judgement in holistic decision making of complex knowledge, skills and behaviours. Although educationally sound, programmatic assessment is highly complex educational approach-both i its design and implementation. In this large-scale implementation study of programmatic assessment, we unpacked the implementation factors, as perceived by students and faculty, using critical realist perspectives. 

Data was derived from in-depth focus groups with medical students and interviews with the faculty. Based on critical realist methodology, Bhaskar’s concept of ontological stratification as a theoretical framework allowed unpacking the domains of reality of student and faculty experiences of programmatic assessment namely, the empirical (data gathered from observations and experiences), the actual (events or non-events that students and faculty report within the assessment program), and the real (underlying causal structures and mechanisms). Archer’s concept of morphogenesis/morphostasis further enabled us to retroduce conditions that may impact the sustenance and growth of programmatic assessment as a complex change. 

We found a significant mismatch and miscommunication between the intended program theories and observable/ reported outcomes. We theorise underlying mechanisms as a state of anomie (sense of alienation and dysfunctionality); agnosis (superficial implementation without attention to structural agility and cultural adaptability) and agenesis (naïve, incomplete, and eclectic system of assessment without attention to underlying education design). 

Achieving balance between agency, structure, and culture can promote sustained changes in assessment practices. Promoting collective reflexivity and agency among faculty and students can be achieved via optimising assessment structures by explicit integration of theory with practice and changing learning culture to promote faculty and students’ acceptance and trust related to the new norms, beliefs and behaviours in assessing for, as and of learning. 

References (maximum three) 

Archer, M. 1995. Realist social theory: The morphogenetic approach. Cambridge university press. 

Bhaskar, Roy. 1975. A realist theory of science: Routledge 

Roberts, C., Khanna, P. et al, 2022. Student perspectives on programmatic assessment in a large medical programme: A critical realist analysis. Medical Education, 56(9), pp.901-914.