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Glossary of Medical Education Terms
Glossary of Medical Education Terms
AMEE Occasional Paper No 3
Andrzej Wojtczak
Institute for International Medical Education, White Plains, New York, USA
This AMEE Education Guide is serialised in Medical Teacher in seven parts from 2002, Vol 24(2), to 2003, Vol
25(2). The Editorial Medical Education Terminology by Andrzej Wojtczak was published in Medical Teacher
2002, 24(4): 357
The Author
Andrzej Wojtczak MD, D.MSc, is Professor in the School of Public Health and Social Medicine, Warsaw.
He is an internist and kidney disease specialist by training. He served as Director in the Regional Office
of World Health Organization in Copenhagen, and coordinated cooperation of WHO European Office
with the Association for Medical Education in Europe, Association of Medical Deans in Europe (now
AMSE) and Association of the Schools of Public Health in Europe. In addition, he served as the President
of the Association for Medical Education in Europe, and he has also held the position of Deputy Minister
of Health in Poland. Before assuming the post of Director of the Institute for International Medical Education
in New York in 1999 he established and operated the WHO Research Center for Health Development in
Kobe, Japan, and served as the Dean of the School of Public Health and Social Medicine in Warsaw. He
is the author of about 300 publications from medicine, medical education and public health, and the
editor of a three-volume textbook on Internal Medicine.
Guide Series Editor: Pat Lilley
Desktop Publishing: Lynn Bell
© AMEE 2003
ISBN: 1-903934-28-1
Copies of this and other Occasional Papers, Education Guides and BEME Guides are available from:
AMEE, Tay Park House, 484 Perth Road, Dundee DD2 1LR, Scotland, UK
Tel: +44 (0)1382 631953 Fax: +44 (0)1382 645748 Email: amee@dundee.ac.uk Website: http:\\www.amee.org
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Glossary of Medical Education Terms
Part 1
Editorial: Medical Education Terminology
Many who participate in conferences on medical
education quite often face difficulty in understanding
new educational terms and concepts introduced by
speakers. Looking for definitions or descriptions is
often not an easy task. Furthermore, when searching
various dictionaries and publications, one learns that
the definitions of many terms, if they do in fact exist,
are often equivocal or unrelated to medical education.
There is universal agreement on the importance of
common understanding of various terms and
methods, especially in view of rapidly growing
globalization of medical education and the use of
different languages for communication. In addition,
the concept of continuous medical education that links
undergraduate with postgraduate and continuing
education (CME) demands that the terms used in
different stages and by different people have the same
meaning for all partners in the educational process.
The Glossary was prepared with the intention of
assisting in communication among medical
educators. The developed formulations of educational
definitions, terms and methods derive from different
sources such as dictionaries, encyclopedias,
glossaries, articles and the Internet. An attempt has
been made to present as clearly as possible the most
broadly accepted views. The greatest difficulty is that
there are often quite significant differences in
definitions of the same or similar concepts and terms.
Unfortunately, this is often the case in multi-
professional fields such as medical education.
Over the past few decades, many changes in medical
education, in particular at the undergraduate level,
were introduced. Increasingly innovative curricula,
methods and educational tools were developed
through the cooperation of medical professionals with
pedagogues, sociologists, psychologists, information
specialists and those in many other related
professions. However, they have helped bring to
medical education various concepts, definitions and
vocabularies not known before to medical
professionals. In many cases, this has quite
unintentionally caused confusion, controversy and
misunderstanding, as the vocabulary used by
disciplines outside medicine often have different focus
and meaning.
The dictionary format has been chosen for the
Glossary in order to provide answers to specific
questions, as well as short descriptions to give a wider
understanding of each term or method. All of the terms
discussed are presented in relation to their relevance
for medical education. As population health and
information management are becoming a more and
more broadly integral part of undergraduate medical
education, the Glossary includes also the most
important terms from these areas as well as terms
used in the administration and management of health
systems. In addition, the Glossary includes short
descriptions of some important associations and
organizations involved in medical education.
In all branches of science and the arts, terms are
often used with meanings specific to subject and
context. As the number of new concepts is growing,
the meaning of some definitions may therefore not
be clear to all readers, especially if they are developed
in different languages. Therefore it was not intended
to provide absolute conclusive definitions in all cases.
Some of the entries may prove to be controversial
when read by medical educators from different
professional backgrounds. The Glossary aims to
stimulate discussion in a field that is full of debate
and different ideas.
Finally, the author would like to encourage and
welcome any criticism, corrections, additions and
proposals for change in the formulation of different
terms, to be considered for the next edition of the
Glossary. It is hoped that this publication will enable
better understanding and communication between
educators. It is hoped, also, that this will help to put
current discussions about medical education in
context.
Andrzej Wojtczak
Comments may be sent to the AMEE Office for
onward transmission to Dr Wojtczak:
amee@dundee.ac.uk
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Glossary of Medical Education Terms
Part 2
Glossary of Medical Education Terms
Accessibility
A measure of the ease with which a specific population
can obtain appropriate health services and be served
by facilities within the health care system. This
concept is used to detect inequity in the availability of
health services for different populations defined
geographically, socially or in terms of their race,
ethnicity, gender or clinical condition.
Accreditation
A self-regulatory process by which governmental, non-
governmental, voluntary associations or other
statutory bodies grant formal recognition to
educational programs or institutions that meet stated
criteria of educational quality. Educational programs
or institutions are measured against certain standards
by a review of written information, self-studies, site
visits to the educational program, and thoughtful
consideration of the findings by a review committee.
Whereas programs or institutions are accredited,
individual physicians are licensed or certified.
Administration
A system whereby public or private enterprises
conduct their business. Administration is concerned
with planning, programming and evaluation. Along
with administration there must be consideration of
management, which as a part of administration, is a
rational technique enabling administrators to fully
develop their human, technical and financial
resources. The term “administration” is often used to
denote broad policy, and the term “management” to
denote the execution of such policy.
American Medical Association (AMA)
According to its mission statement, this professional
association represents the voice of the American
medical profession and constitutes the partnership
of physicians and their professional associations
dedicated to promoting the art and science of
medicine and the betterment of public health. The
AMA serves physicians and their patients by
establishing and promoting ethical, educational, and
clinical standards for the medical profession and by
advocating the highest principle of all: the integrity of
the physician/patient relationship.
http://www.ama-assn.org/
Assessment
A system of evaluation of professional
accomplishments using defined criteria and usually
including an attempt at measurement either by
grading on a rough scale or by assigning numerical
value. The purpose of assessment in an educational
context is to make a judgment about the level of skills
or knowledge, to measure improvement over time, to
evaluate strengths and weaknesses, to rank students
for selection or exclusion, or to motivate. Assessment
should be as objective and reproducible as possible.
A reliable test should produce the same or similar
scores on two or more occasions or if given by two or
more assessors. The validity of a test is determined
by the extent to which it measures whatever it sets
out to measure. One can distinguish three types of
assessment:
Formative assessment is testing that is part of the
developmental or ongoing teaching/learning
process. It should include delivery of feedback to
the student.
Summative assessment is testing which often
occurs at the end of a term or course, used
primarily to provide information about how much
the student has learned and how well the course
was taught.
Criterion-referenced assessment refers to testing
against an absolute standard such as an
individual’s performance against a benchmark.
Association for Medical Education in Europe
(AMEE)
A worldwide association concerned with education in
the medical and health care professions – teachers,
curriculum developers, deans, administrators,
researchers and students. AMEE works with the
continuum of education and its quality, the facilitation
of high quality research in medical education and
serves as a source of advice on matters relating to
medical education. AMEE assists with the
development of skills required by medical teachers
and facilitates the exchange of information on medical
education. AMEE is concerned with the development
of medical education to meet current and future
needs, particularly in the European context. The
AMEE Office is located at the Centre for Medical
Education, University of Dundee, Scotland.
http://www.amee.org/
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Glossary of Medical Education Terms
Association of American Medical Colleges
(AAMC)
A nonprofit association consisting of the 125
accredited United States medical schools, the 16
accredited Canadian medical schools, more than 400
major teaching hospitals and health systems, some
90 academic and professional societies representing
75,000 faculty members, and the nation’s medical
students and residents. The purpose of the AAMC is
to improve health through the advancement of
academic medicine, and in pursuing this purpose, the
AAMC works “to strengthen the quality of medical
education and training, to enhance the search for
biomedical knowledge, to advance research in health
services, and to integrate education into the provisions
of effective health care”. The AAMC is responsible
for the Medical College Admission Test (MCAT)
required of each applicant to medical school in the
U.S. and Canada.
http://www.aamc.org/
Basic Science Years
A term that usually refers to the initial two years of a
medical school’s program. However, in some schools,
this may entail more or less than two years. With the
introduction of new learning methodologies such as
Problem-Based Learning (PBL) and early exposure
to patients, basic science learning has become more
integrated with clinical instruction and the division
between basic science years and clinical years has
eroded.
Bedside Teaching
A part of clinical rounds where both student and
instructor attend the patient’s bedside to discuss the
case and/or demonstrate a clinical procedure. This
is the student’s opportunity to see how the attending
physician relates to the patient and to get hands-on
instruction in interviewing a patient, physical
examination, and counseling skills.
Best Evidence Medical Education (BEME)
Methods and approaches used by teachers of medical
education based on the best available evidence as
opposed to opinion-based education. BEME should
take into account these factors: how reliable the
evidence is as well as its utility, extent, strength, validity
and relevance. It calls for critical appraisal of available
literature and existing databases and identifying any
existing gaps.
http://www.bemecollaboration.org/
Case Management
Coordination of services to help meet a patient’s
health care needs, especially when the patient
requires multiple services from multiple providers.
This term is also used to refer to coordination of care
during and after a hospital stay.
Certification
The process by which governmental, non-
governmental or professional organizations or other
statutory bodies grant recognition to an individual who
has met certain predetermined specified
qualifications. In most cases, such recognition is on
a voluntary basis.
Chart Stimulated Recall Oral Examination (CSR)
A measurement tool for assessing clinical decision-
making and the application of medical knowledge
using actual patients and a standardized oral
examination. A trained and experienced physician/
examiner questions the examinee about the provided
care, probing for the reasons behind the work-up
diagnoses, interpretation of clinical findings and
treatment plans. The examiners rate the examinee
using an established protocol and scoring procedure.
In an efficiently designed CSR, each patient case (test
item) takes 5 to 10 minutes. A typical CSR exam
involves one or two physicians as examiners per
separate 30 to 60-minute sessions. The examinee’s
performance is measured by combining scores from
all the cases tested for a pass/fail decision overall, or
by scoring for each session. Exam score reliabilities
have been reported between 0.65 and 0.88. In
assessing recall ability or medical knowledge,
multiple-choice questions (MCQ) are more effective
than CSR exams.
Checklist Evaluation
A method that is useful for assessing any competency
or competency component that can be broken down
into specific behaviors or actions. To obtain consistent
scores and satisfactory reliability of observed
performance using checklists, trained evaluators are
required. To ensure the validity of content and scoring
rules, checklist development requires consensus by
several experts on the essential behaviors, actions
and criteria for evaluating performance. The
usefulness of checklists is well documented for
evaluation of patient care skills (history and physical
examination) and interpersonal and communication
skills. Checklists have also been used for self-
assessment of practice-based learning skills, and in
addition are very useful in providing feedback on
performance.
Clerkships
A rotation around the clinical settings of the medical
school. Some clerkships are obligatory (e.g., internal
medicine, pediatrics, surgery), while others are
elective or selective. In the United States, medical
students do clerkships in their third and fourth year
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Glossary of Medical Education Terms
while in Europe, this typically occurs in the fourth
through sixth year of medical school.
Clinical Competence
The mastery of relevant knowledge and the
acquisition of a range of relevant skills at a satisfactory
level including interpersonal, clinical and technical
components at a certain point of education, i.e., at
graduation. In the case of clinical training, which is
primarily based on an apprenticeship model, teachers
define what the student is expected to do and then
test their ability to do it. However, in actuality, most
clinical actions are concerned with problems for which
there are no clear answers and no single solution. In
such situations, an experienced doctor searches his
or her mind and sifts through a wide range of options
and in some cases the solution will be something he
or she has never arrived at before. Therefore,
competence itself is only of value as a prerequisite
for performance in a real clinical setting and does not
always correlate highly with performance in practice.
Clinical Oral Examination (COE)
Unstructured clinical and oral examination which is
the traditional form of clinical examination and
continues to be popular in many parts of the world.
With face-to-face contact, examiners explore both the
breadth and depth of a student’s understanding in
real-life clinical situations. Aspects of competence
which can be tested include the ability to respond to
new information, a variety of interpersonal skills, and
those aspects of competence that cannot be easily
measured by more objective methods, such as an
OSCE. Case variability can be reduced by recruiting
a small group of patients with the same condition and
similar symptoms or by the use of simulated patients.
The use of videotapes of students undertaking a long-
case examination with subsequent scoring of the
performance by the examiner, who then discusses
the results with the examinee, enhances the value of
this form of examination. Proper briefing and training
of examiners and a very structured approach to
scoring contribute to the quality of this exam.
Communication
The process by which information and feelings are
shared by people through an exchange of verbal and
non-verbal messages. In the context of medical
education, its primary function is to establish
understanding between patient and doctor. In an
atmosphere of effective communication, patients
improve faster, cope better with post-operative pain,
require less psychotropic drugs, and experience
numerous other health benefits.
Communication Skills
The term denotes proficiency in the interchange of
information. These are essential skills for clinical
practitioners because of the large and varied number
of people they must communicate with every day. The
idea that doctors automatically learn communication
through experience or that doctors are inherently
either good or bad communicators is being largely
abandoned. It is now widely believed that such skills
can be taught to both students and doctors by a variety
of professionals including doctors and specialists in
communication skills as an important part of
undergraduate as well as postgraduate and continuing
medical education.
Community
A group of individuals living together in some form of
social organization with cohesion in planning and
operation and/or manifesting some unifying trait or
common interest. In health care organization, it refers
to the most local level of the health system. The form
of services provided to a locality will vary according
to each country’s political, economic, social, cultural
and epidemiological patterns.
Community Diagnosis
Appraisal of the health status of a community in
general or limited to specific health conditions,
determinants or subgroups.
Community Medicine
Denote the specialty that deals with the health and
disease of a population or of a specified community.
The goal is to identify health problems and needs, to
identify means by which these needs may be met,
and to evaluate the extent to which health services
do so. Community medicine is concerned with
specified populations rather than individuals.
Community-Based Education (CBE),
Community-Based Learning (CBL), or
Community-Based Teaching (CBT)
A form of instruction where trainees learn professional
competencies in a community setting focusing on
population groups and also individuals and their
everyday problems. The amount of time students
spend in the community and organizational settings
may vary. Instruction may take place at a general
practice, family planning clinic, community health
center or a rural hospital. During their training in the
community, students learn about social and economic
aspects of illness, about health services in the
community and methods of health promotion, about
working in teams, and about frequency and types of
problems encountered outside a hospital setting.
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Glossary of Medical Education Terms
Competence
Possession of a satisfactory level of relevant
knowledge and acquisition of a range of relevant skills
that include interpersonal and technical components
at a certain point in the educational process. Such
knowledge and skills are necessary to perform the
tasks that reflect the scope of professional practices.
Competence may differ from “performance”, which
denotes actions taken in a real life situation.
Competence is therefore not the same as “knowing”.
On the contrary, it may well be about recognizing one’s
own limits. The more experienced the professional
being tested, the more difficult it is to create a tool to
assess their actual understandings and the complex
skills of the tasks they undertake. A holistic integration
of understandings, abilities and professional
judgments, i.e., a “generic” model, is one where
competence is not necessarily directly observable,
but rather can be inferred from performance.
Constructed Response Questions
A method of written examination in which examinees
are required to construct their responses as opposed
to selecting them from a set of options.
Continuing Medical Education (CME)
A continuous process of acquiring new knowledge
and skills throughout one’s professional life. As
undergraduate and postgraduate education is
insufficient to ensure lifelong physicians’
competencies, it is essential to maintain the
competencies of physicians, to remedy gaps in skills,
and to enable professionals to respond to the
challenges of rapidly growing knowledge and
technologies, changing health needs and the social,
political and economic factors of the practice of
medicine. Continuing medical education depends
highly upon learner motivation and self-directed
learning skills.
Cost-Benefit Analysis
A comparison of all the costs and benefits of a given
activity or program expressed in monetary terms. It
is used for the allocation of funds in health care
services. This form of analysis permits one to
measure the costs for reaching particular objectives.
In the case of health programs, benefits are often
difficult to express in monetary terms, and
furthermore, benefits may extend beyond the
achievement of the desired effect, which makes such
evaluation difficult.
Cost-Containment
Denote the measures taken to control or restrict
medical care expenditures or to reduce the rate of
their growth. This includes a broad range of cost
control mechanisms e.g. limiting budgets, cost-
sharing, regulation of supply of services and staff,
patients’ waiting lists, exclusion of certain people from
entitlement to services, standard costing, privatization,
and managed competition.
Cost-Effectiveness Analysis
A method for evaluating the relationship between the
cost and the effectiveness of an activity or to compare
similar or alternative activities to determine the relative
degree to which they will produce the desired
objectives or outcomes. The degree of effectiveness
is understood to be the extent to which a given activity
or program contributes to attaining the objectives of
reducing the dimension of a problem or improving an
unsatisfactory situation. The preferred action is the
one that requires the least cost to produce a given
level of effectiveness. In the health care field, the cost
is expressed in monetary terms but the consequences
may be expressed in physical units such as healthy
life-years gained, the number of cases of disease
detected or the improvement in health status of a
population.
Cost-Efficiency Analysis
A method for evaluating program or activity efficiency
such as the extent to which resources are being used
as productively as possible. In health care, it
measures medical services provided in relation to their
cost. This enables comparison between different
health care providers.
Curriculum
An educational plan that spells out which goals and
objectives should be achieved, which topics should
be covered and which methods are to be used for
learning, teaching and evaluation.
Demand
A need or desire for a product or service. Price,
availability and quality of the product all affect demand.
Demand for health services is often difficult to assess
and surveys of willingness to pay may be necessary
to estimate its scope or extent.
Determinant
Any factor, event, characteristic, or other definable
entity that brings about change in a health condition
or other defined characteristic.
Diagnosis
The process of determining health status and the
factors responsible for producing it; it may be applied
to an individual, family, group or community. The
diagnosis should take into account etiology, pathology,
and severity of the clinical state.
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Glossary of Medical Education Terms
Direct Observations or Performance Audits
A traditional approach for giving a firsthand
assessment of skills and performance with immediate
feedback to the student. The student is observed
performing a complete history and examination which
provides the best possible opportunity for the observer
to make multiple judgments over a period of time in a
variety of clinical situations. Use of observation
checklists, training the raters and agreed-upon
standards increase reliability and validity of these
methods over the use of global rating forms which
require additional resources. This approach has an
advantage over most new methods.
Discipline-Based Approach
Teaching of the individual classical medical disciplines
such as anatomy, biochemistry, pathology, surgery
or community medicine as separate educational
building blocks. It is expected that this approach lays
the foundation for contact with patients which tends
to occur later, after completion of the basic science
course. In this approach, it is left to the student to put
together the knowledge gained in each discipline to
form an overall picture of medicine.
Disease
A general term used to refer to any departure from
health in which a patient suffers. It can be defined as
disorder of bodily function or destructive processes
in organs, organs’ systems or in an organism with
recognizable signs and symptoms, and in many cases
a known cause. The words disease, illness and
sickness are used often interchangeably but are not
synonymous. Rather, whereas disease relates to a
physiological or psychological dysfunction, an illness
is the subjective state of a patient who feels unwell
and sickness encompasses a state of social
dysfunction, such as the role that the individual
assumes when ill.
Doctor
See Physician.
Domain
Denote a scope of knowledge, skills, competencies
and professional characteristics which can be
combined into one cluster and should be learned
during undergraduate medical studies.
E-Health
A term that refers to all forms of electronic health
services provided over the Internet. It includes all
educational, information and commercial services and
products offered by professionals, non-professionals,
businesses and consumers. Based on the unique
capabilities of Internet, E-Health is enabling the
delivery of clinical services that previously have been
the domain of telemedicine and telehealth. E-health
differs from telemedicine and telehealth in that it is
not “professional-centric” and is motivated by the
financial gain, whereas telemedicine and telehealth
are not. As it is Internet-based, E-health is making
the provision of health care more efficient.
Educational or Instructional Objectives
Statements that describe what learners should be able
to master. A major aim is the acquisition of facts,
concepts and principles. Developing instructional
objectives involves learning the fundamentals and
vocabulary of each discipline and developing a logical
progression of concepts in each discipline. Resources
and materials are more effectively deployed when
instructional objectives are explicit. It is important to
assure that objectives are measurable and that they
delineate a specific level of competence. One can
and should distinguish between knowledge, skill and
attitude objectives.
Effectiveness
A measure of the extent to which a specific
intervention, procedure, regimen, or service, when
deployed in the field in routine circumstances, does
what it is intended to do for a specified population. In
the health field, it is a measure of output from those
health services that contribute towards reducing the
dimension of a problem or improving an unsatisfactory
situation.
Efficacy
The ability to produce the necessary or desired result.
Efficiency
An ability to perform well or achieve a result without
wasting energy, human resources, effort, time or
money. Efficiency can be measured in physical terms
(technical efficiency) or terms of cost (economic
efficiency). Greater efficiency is achieved where the
same amount and standard of services are produced
for a lower cost, if a more useful activity is substituted
for a less useful one at the same cost or if needless
activities are eliminated.
Elective Program
An educational program where students are given the
opportunity to select subjects or projects of their own
choice, not covered by obligatory medical courses.
This enables students to pursue individual aspirations,
provides students with increased responsibility to
further their own learning, and facilitates career choice
by providing an opportunity to explore various areas
of interest.
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Glossary of Medical Education Terms
Equity
A state of being fair or equal; equity in health implies
the ideal that everyone should have a fair opportunity
to attain his or her full health potential. More
pragmatically, it implies that no one should be
disadvantaged by being prevented from achieving this
potential. The term inequity refers to differences in
health, which are not only unnecessary and avoidable
but, in addition, are considered unfair and unjust.
Essays or Open-Ended Questions
An assessment method, distinguished from short-
answer questions by the scope, the length of required
answers, and the relative lack of specific cues for
recall. Essay questions typically deal with larger issues
and are based on information that is spread out over
a number of learning sources. Students’ answers
should reflect both how much is known about a topic
and how well organized knowledge of the subject is.
As essay questions and answers are comparatively
complex, more abilities are displayed than with other
question types. They may be used to assess
knowledge of basic and clinical science and its
application to clinical problems. They provide
information about the respondent perceptions,
reasoning abilities, attitudes, feelings, and
experiences. Because such questions typically require
extensive knowledge as well as analytical and writing
skills, they perhaps are best suited for deciding who
the top students in a course are. The essential
weakness of essay questions is that they can be
ambiguous, difficult to grade reliably and require
scorers with relevant knowledge and training.
Ethics
The branch of philosophy that deals with distinctions
between right and wrong and with the moral
consequences of human actions. Examples of ethical
issues that arise in medical practice and research
include informed consent, confidentiality, respect for
human rights, and scientific integrity.
Evaluation
A process that attempts to systematically and
objectively determine the relevance, effectiveness,
and impact of activities in light of their objectives.
Evaluation can be related to structure, process, or
outcome. One can distinguish these various types:
Formative individual evaluation provides feedback
to an individual (usually a learner) in order to
improve that individual’s performance. This type
of evaluation identifies areas for improvement and
provides specific suggestions for improvement
serving as an educational tool.
Summative individual evaluation measures
whether specific objectives were accomplished by
an individual in order to place a value on the
performance of that individual. It may certify
competency or lack of competency in performance
in a particular area.
Formative program evaluation provides
information in order to improve a program’s
performance. It usually takes the form of surveys
of learners to obtain feedback about and
suggestions for improving a curriculum.
Quantitative information such as ratings of various
aspects of the curriculum can help identify areas
that need revision. Qualitative information, such
as responses to open-ended questions about
program strengths and weaknesses, as well as
suggestions for change, provide feedback in areas
that may not have been anticipated and provide
ideas for improvement. Information can also be
obtained from faculty or other observers, such as
nurses and patients.
Summative program evaluation measures the
success of a curriculum in achieving learner
objectives for all targeted learners, its success in
achieving its process objectives, and/or its success
in engaging, motivating, and pleasing its learners
and faculty. In addition to quantitative data,
summative program evaluation may include
qualitative information about unintended barriers
or unanticipated effects encountered in program
implementation.
Formative evaluations generally require the least
amount of rigor, whereas summative individual and
summative program evaluation for external use (e.g.,
certification of competence) requires the greatest
amount of rigor. When a high degree of
methodological rigor is required, the measurement
instrument must be appropriate in terms of content,
reliability, validity, and practicality.
Evaluation, 360-Degree
A method used to assess interpersonal and
communication skills, professional behaviors, and
some aspects of patient care and systems-based
practice. Usually, evaluators completing rating forms
in a 360-degree evaluation are superiors, peers,
subordinates, and patients and their families. Most
360-degree evaluation processes use a surveyor
questionnaire to gather information about an
individual’s performance on several topics, such as
teamwork, communication, management skills, and
decision-making. Most 360-degree evaluations use
rating scales to assess how frequently a behavior is
performed. The ratings are summarized for all
evaluators by topic and also overall to provide
feedback. Such feedback is more accurate when the
evaluation is intended to give formative feedback
rather than summative. Reproducible results are
easily obtained when several evaluators rate
examinees; a greater number of faculty and patients
are needed for a greater degree of reliability.
– 9 –
Glossary of Medical Education Terms
Faculty Development
Because faculty members may be experts in their
subject but may not have received special training in
educating others, faculty development programs exist
to enable these teachers to acquire the necessary
professional knowledge, skills, attitudes and tools. It
is an essential component for obtaining high reliability
and validity of applied assessment on a day-to-day
basis. It also enhances ongoing formative evaluation
so that students are given feedback to help them
improve continuously. Faculty development activities
can be organized as series of special workshops,
readings, or individualized feedback sessions. Since
teaching is considered a very important aspect of a
physician’s work, such educational programs are often
viewed as a form of Continuing Medical Education.
Faculty-Ratings Questionnaires
Questionnaires completed by faculty members that
are used in the assessment of student deficiencies
and achievements as well as professional behavior
and competence. They provide indirect, inexpensive
measures of clinical skills attainment and real-life
students’ performance. However, Faculty-Ratings
Questionnaires are subject to rating biases.
Flexner Report
The report researched, written and published by
Abraham Flexner (1866-1959) in 1910 for the
Carnegie Foundation and entitled “Medical Education
in the United States and Canada” is known today as
the Flexner Report. It triggered much-needed reforms
in the standards, organization, and curriculum of North
American medical schools. At the time of the Flexner
Report, many medical schools were proprietary
schools operated more for profit than for education.
Flexner proposed that medical schools operate
instead in the German tradition of combining strong
biomedical sciences with hands-on clinical training.
The report caused many medical schools to close
down. It remains one of the most important
publications on medical education in the 20th century.
Abraham Flexner was not a doctor, but a secondary
school teacher and principal for 19 years in Louisville,
Kentucky. He did graduate work at Harvard University
and the University of Berlin and joined the research
staff of the Carnegie Foundation for the Advancement
of Teaching. In 1930, Flexner founded the Institute
for Advanced Study at Princeton University and served
as its first director. Albert Einstein joined the Institute
in 1933. Flexner was one of the great educators of
the 20th century. Modern medical education and
medicine in North America owes a large debt to him.
Global Minimum Essential (Core) Requirements
Specification of the competencies related to
knowledge, skills, professional attitudes and ethical
values which students should possess at graduation,
regardless of where they are trained. In medical
education, this is represented as a three-tiered
structure with international, national, and local layers,
which reflects the competencies specific to given
settings and cultures where the physician will practice
in addition to universal competencies required by
physicians throughout the world.
Global-Rating of Live or Recorded
Performance Forms
Ratings by faculty supervisors to assess trainees’
medical knowledge, interpersonal and communication
skills and patient care clinical skills which are
completed retrospectively and are based on general
impressions collected over a period of time. They are
derived from multiple sources of information such as
direct observations or interactions, input from other
faculty, residents or patients; review of work products
or written materials. They differ from other rating forms
in that a rater judges general categories of ability and
skills rather than specific skills, tasks or behaviors.
The rating forms contain scales used by the evaluator
to judge knowledge, skills, and behaviors listed on
the form. Scoring these forms entails combining
numeric ratings with comments to obtain a useful
judgment about performance based upon more than
one rater. Reproducibility appears easier to achieve
for ratings of knowledge and more difficult to achieve
for patient care and interpersonal and communication
skills. To improve reproducibility, the rater should be
well trained; otherwise the scores can be highly
subjective and competencies may be rated similarly
regardless of performance.
Goal
A general aim, object or end-effect which one strives
to achieve.
Graduate Medical Education (GME)
In the United States, this term typically refers to
residency training and fellowships; the education
physicians receive after finishing medical school. In
many other countries it is called specialty training or
postgraduate education.
Graduate Training or Internship
The phase of acquiring widening clinical experience
through the practice of basic clinical skills and
judgment. This is normally used to designate the
period of hospital clerkship. The periods of
undergraduate education and graduate training
together comprise the doctor’s basic medical
education.
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Glossary of Medical Education Terms
Guidelines
A set of steps to be taken in performing a task or
implementing a policy, program or activities and the
manner of doing so. Guidelines are more specific and
more detailed than guiding principles, on which they
are based.
Health
In accordance with the Constitution of the World
Health Organization (1948), health is “a state of
complete physical, mental and social well-being and
not merely the absence of disease or infirmity”. Health
is defined here as a positive concept, emphasizing
social and personal resources as well as physical
capabilities.
Health Care
Services provided to individuals or communities by a
health care system or by professionals to promote,
maintain, monitor, or restore health. Health care
contains a broad spectrum of services and activities
delivered by a team of health personnel. This
contrasts with medical care, which concentrates on
diagnostic and therapeutic actions performed by or
under the supervision of an individual physician.
Health Economics
A discipline which concentrates on the application of
the principles and rules of economics in the sphere
of health. In broad terms, it includes analysis and
evaluation of health policy and the health system from
an economic perspective. In particular, it includes
health system planning, market mechanisms,
demand for and supply of health care, micro-
economic evaluation of individual diagnostic and
therapeutic procedures, determinants of health and
its valuation, and evaluation of the performance of
health care systems in terms of equity and allocative
efficiency.
Health Maintenance Organization (HMO)
An organization that arranges a wide spectrum of
health care services which commonly include hospital
care, physicians’ services and many other kinds of
health care services with an emphasis on preventive
care.
Health Maintenance Services
Any health care service or program that helps maintain
an individual’s good health. This includes all
preventive medical practices such as immunizations
and periodic examinations, as well as health education
and special self-help programs.
Health Management
Systematic use of the full range of human, technical
and financial resources of the health system through
planning, organizing, leading and controlling the effort
of members to achieve stated goals and to render
optimum services at minimum cost. Health managers
achieve desired goals by directing and influencing
subordinates, and organizing others to perform
essential tasks to ensure that the organization is
moving towards its goal of improving health.
Health Plan
A term that has different meanings depending upon
the context. “Health plan” can be used to mean an
HMO; a “health benefits plan” is provided by an
employer to its employees, or services offered by an
insurer or third party administrator to employers and/
or employees.
Health Policy
A set of decisions or commitments to pursue courses
of action aimed at achieving defined goals of
improving health. Policies usually state or imply the
values that underpin the policy position. They may
also specify the source of funding that can be applied
to planning and implementation of policy and to
relevant institutions to be involved in this process.
Health Promotion
The process of enabling individuals to increase control
over and improve their health. It involves the
population as a whole in the context of their everyday
lives, rather than focusing on people at risk for specific
diseases, and is directed toward action on the
determinants or causes of health.
Health Risks Appraisal
A method of describing an individual’s probability of
becoming ill or dying from selected causes. Starting
from the average risk of death for that individual’s
age and sex, various lifestyle and physical factors
are considered and it is determined whether the
individual is at greater or lesser than average risk
from the commonest causes of death for their age
and sex. Health risk appraisal also indicates the
reduction in risk which could be achieved by the
individual’s altering any of the causal factors (such
as cessation of cigarette smoking).
Health Services
Services performed by health care professionals or
by others under their direction for the purpose of
promoting, maintaining, or restoring health. In addition
to personal health care, health services include health
protection, health promotion, and disease prevention.
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Glossary of Medical Education Terms
Health Status
A general term for the state of health of an individual,
group or population that reflects the degree to which
a person is able to function physically, emotionally,
and socially, with or without aid from the health care
system.
Health System
A complex of interrelated elements that contribute to
health in homes, educational institutions, workplaces,
public places, and communities. A health system is
usually organized at multiple levels, starting at the
most local level, also known as community or primary
health care level, and proceeding through the
intermediate (district, regional or provincial) to the
central level, providing progressively more complex
and more specialized care and support.
Healthy Behavior
The combination of knowledge, practices and
attitudes that together contribute to motivate actions
we take regarding our own health. Healthy behavior
may promote and preserve good health. On the other
hand, behaviors harmful to health such as tobacco
smoking, alcohol drinking, drug abuse and lack of
physical exercise may be determinants of disease.
Hippocratic Oath
An affirmation usually taken by physicians about to
enter the practice of medicine. It is attributed to Greek
physician, Hippocrates of Cos, who is called the
“Father of Medicine” (circa 460-377 B.C). Its content
reflects the ethical code of the physicians’ attitudes
and behavior and obligations towards patients,
colleagues and society. The complete text can be
found here.
Indicator
A variable that helps to measure changes directly or
indirectly and permits one to assess the extent to
which objectives and targets of a program are being
attained. In medicine, indicators help to measure
changes in the health situation of a population.
Information Management
A method used to organize information to avoid
information overload and to keep information in a
format that is efficient to retrieve whenever needed.
Filing systems, cognitive maps, manuals, and
electronic databases are examples of devices that
can prove useful in information management. A
network of consultants is an additional way to ensure
that necessary information will be readily available.
Institute for International Medical Education
(IIME)
A non-profit medical Institute established in 1999 by
a grant from the China Medical Board of New York,
which began its own operations in 1914 as a division
of The Rockefeller Foundation. The IIME has been
entrusted with the development of ‘Global Minimum
Essential (Core) Requirements’ which include
knowledge, clinical skills, professional ethical values
and fundamental competencies to the practice of
health care worldwide. These essential requirements
represent only a portion of the educational experience,
since each country and even each medical school
has unique needs that the educational curriculum
should address. Three committees composed of
medical experts from around the globe supervise the
work of IIME: the Core Committee, the Steering
Committee and the Advisory Committee. The Institute
is located just outside of New York City in suburban
White Plains, New York.
http://www.iime.org/
Integrated Teaching
A method of teaching that interrelates or unifies
subjects frequently taught in separate academic
courses or departments. In integrated teaching,
subjects are presented together as a meaningful
whole. Integration may be vertical or horizontal.
Horizontal integration functions between parallel
disciplines such as anatomy, histology,
biochemistry or medicine, surgery and
pharmacology.
Vertical integration functions between disciplines
traditionally taught in different phases of
curriculum; it can occur throughout the curriculum
with medical and basic sciences beginning
together in the early years.
Internship
A first postgraduate training year in which graduates
practice medicine under supervision. In some
countries, this is a requirement for licensure. In many
countries and for many specialties such as internal
medicine, pediatrics and surgery, this is the first year
of residency. However, as there are some specialties
that are too narrow to provide a broad medical practice
experience, those residents may have to attend a
transitional year in one of the above specialties or a
rotating internship.
Knowledge
The acquisition or awareness of facts, data,
information, ideas or principles to which one has
access through formal or individual study, research,
observation, experience or intuition.
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Glossary of Medical Education Terms
Learner-Centered Education
A method of teaching in which the students’ needs
have priority. Learners are responsible for identifying
knowledge gaps, actively participating in filling them,
and keeping track of their learning gains. Teachers
are expected to facilitate this process instead of
supplying “spoon-fed” information. This approach
increases the students’ motivation to learn and
prepares them for self-learning and continuous
education. Learner-centered education is the opposite
of teacher-centered education.
Lecture
An instruction or verbal discourse by a speaker before
a large group of students. This teaching method has
historically been quite prominent in education because
it is an economic way to communicate information to
large groups. However, increasing knowledge about
the group’s difficulties in maintaining concentration
and absorbing extensive information while in a passive
listening mode has brought the value of lectures under
criticism. Audiovisual presentations, demonstration of
patients and intermittent discussions can help activate
learners.
Liaison Committee on Medical Education – LCME
A group organized under the sponsorship of the
American Medical Association (AMA) and Association
of American Medical Colleges (AAMC) to accredit
educational programs leading to the M.D. degree in
the US and Canada.
http://www.lcme.org/
Licensure
The process by which different governmental or non-
governmental agencies, such as specialty boards or
other bodies, grant permission to practice a profession
to persons meeting predetermined qualifications to
engage in a given occupation or use a particular title.
In the case of physicians, licensure ensures that they
have appropriate education and training and that they
abide by recognized standards of professional
conduct while serving their patients. This is typically
done at a national or local level. In the United States,
licensure is a process by which physicians receive
permission to practice medicine. Candidates for
licensure must first complete the rigorous United
States Medical Licensing Examination (USMLE),
designed to assess a physician’s ability to apply
knowledge, concepts, and principles that are
important in health and disease and that constitute
the basis of safe and effective patient care. All
applicants must submit proof of medical education
and training and provide details about their work
history. Results of the USMLE are reported to state
medical boards for use in granting the initial license
to practice medicine. Each medical licensing authority
requires, as part of its licensing processes, successful
completion of an examination or other certification
demonstrating qualification for licensure.
Life-Long Learning
Continuous training over the course of a professional
career. Because medical science changes so rapidly,
it is vital that its practitioners are committed to and
engage in life-long learning.
Lifestyle
A general manner of living based on the interplay
between living conditions in the broad sense and
individual patterns of behavior as determined by socio-
cultural factors and personal characteristics. The
range of behavior patterns open to individuals may
be limited or extended by social environmental factors.
For this reason, lifestyles are usually considered in
the context of both collective and individual
experiences and general conditions of life. A change
of lifestyle may include such activities as stopping
cigarette smoking, changing the pattern of nutrition
or engaging in regular physical exercise.
Managed Competition
Health care market regulations which use competition
as the means to promote efficiency of the health care
system. Within the framework of government
intervention, managed competition helps to achieve
policy objectives including price control, cost
containment, quality control, control of pattern of
service provision, greater accountability of local
managers, closure of surplus facilities, control of
powerful professional groups and greater equity in
service access.
Medical Education
The process of teaching, learning and training of
students with an ongoing integration of knowledge,
experience, skills, qualities, responsibility and values
which qualify an individual to practice medicine. It is
divided into undergraduate, postgraduate and
continuing medical education, but increasingly there
is a focus on the “lifelong” nature of medical education.
Undergraduate education or basic medical
education refers to the period beginning when a
student enters medical school and ends with the
final examination for basic medical qualification.
This period of education comprises a pre-clinical
and a clinical period. It can result in granting a
license to practice, which may be provisional and
subject to conditions as to supervision; or
permitting the start of postgraduate education. In
the United States, however, undergraduate
education refers to pre-medical college education,
which results in a Bachelor’s degree and is the
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Glossary of Medical Education Terms
training most students receive before entering
medical school.
Postgraduate education, graduate medical
education or specialty training is used to designate
the more or less continuous period of post-basic
training which, when it occurs, normally directly
follows undergraduate training and is designed to
lead to competence in a chosen branch of medical
practice.
Medical Educator
A professional who focuses on the educational
process necessary to transform students into
physicians. Some medical educators are physicians,
but an increasing number have backgrounds in
education, behavioral or other health sciences.
Medical Informatics
Medical informatics is a scientific field that deals with
the storage, retrieval and optimal use of information
and data. Rapid development is due to advances in
computing, communication technology and an
increasing awareness that the knowledge base of
medicine is essentially unmanageable by traditional
paper-based methods.
Medical School
A higher education or university level institution
offering a prescribed course of medicine. The
following are examples of the names that such
institutions may bear and which vary from one country
to another or even within countries: Medical College;
College of Surgeons; Medical Institute; Institute of
Medicine and Pharmacy; Institute of Medicine and
Surgery; Faculty of Medicine; Faculty of Medical
Sciences; Faculty of Medicine and Surgery; Academy
of Medicine or Medical Academy; University Center
for Health Sciences; Medical University; Faculty of
Medicine and Pharmacy.
Minimum Essential Requirements
This specifies the knowledge, skills and attitudes
related to the sciences basic to medicine, clinical
practice, professional behavior and ethical values.
The graduate of undergraduate medical education
should possess these to ensure that he or she is
prepared to begin further graduate medical education
(specialty training) or to start practicing medicine
under supervision.
Modified Essay Question (MEQ)
A measurement instrument which allows for
assessment of clinical reasoning skills, understanding
and knowledge of clinical and basic science and
application of basic science to clinical problems.
MEQs constitute a series of questions which must
be answered in the sequence asked, with no review
and no possibility of correcting previous answers.
Questions must be answered within the allocated time
which may vary from 40 to 90 minutes. In general, a
brief patient clinical scenario (presentation) is followed
by a few questions exploring diagnostic hypotheses
and mechanisms underlying the clinical presentation.
Subsequent questions may focus on applied basic
science, interpretation of diagnostic information,
management issues, disease complications, ethical
issues or prognosis, for example. The initial scenario
is either repeated or reformulated as the reporting
process progresses, and as further information is
provided, the assessed area narrows. Thus, the
medical problem is progressively defined with
questions being directed to increasingly specific
areas. A well-written MEQ assesses the approach of
students to a problem, their reasoning skills and
understanding of concepts, rather than recall of factual
knowledge.
Multiple Choice Questions (MCQ)
An assessment tool that requires examinees to
identify the one correct answer to a question. It
consists of a stem that directly or indirectly poses a
question and a set of distracters from which the
answer is selected. In its simplest form, it comprises
a stem statement followed by related statements
which an examinee marks as either true or false.
Another type asks examinees to select a correct or
best answer from a number of options. In the
‘extended matching’ type test, a short vignette about
a patient is presented and the examinee is asked to
select the best response from approximately 15-20
choices. Such extended matching questions, a
relatively new form of MCQ, reduce the potential for
guessing to marginal terms. The test reliability is
achieved by formulating a large number of well-
constructed questions; this requires considerable skill.
The great strength of the multiple-choice format is its
ease and reliability of scoring. Checking answers is
mechanical and requires neither interpretation nor
special knowledge. Most commonly administered
multiple-choice exams are scored by machine and
provide statistical information about the exam, such
as item difficulty and item-test correlations. For these
reasons, multiple-choice questions are popular
among instructors offering the advantage of allowing
different kinds of questions, at various levels of
difficulty. The computerized version of MCQ can cover
a large area of knowledge in a short space of time.
And poor questions which fail to discriminate between
candidates of different ability can be easily identified.
Using a greater number of questions is beneficial, as
a larger set of questions provides better coverage of
course material, and students’ test scores are more
reliable. The correct answers are pre-specified and
hence marking in some respects is objective. A large
number of examinees can be tested with relatively
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Glossary of Medical Education Terms
few resources. The major disadvantage to multiple-
choice questions is that they are time-consuming to
construct. However, once constructed, multiple-
choice questions can be used again, in either original
or modified form. Since these tests primarily measure
knowledge only, they are now often being replaced
with more performance-based assessment methods.
Objective
In medical education, it is what the learner will be
able to know or do after taking part in educational
activities. Objectives should result from assessment
of the needs of the patient or population.
Objective Structured Clinical Examination
(OSCE)
A method introduced in 1972 as a more standardized
way of assessing clinical competencies. It provides a
standardized means to assess physical examination
and history-taking skills, communication skills with
patients and family members, breadth and depth of
knowledge, ability to summarize and document
findings, and ability to make a differential diagnosis
or plan treatment. The examiners carefully plan the
tested areas and objectives of the test are identified
and recorded. The clinical competency to be tested
is broken down into its various components such as
taking a history, auscultation of the heart, interpretation
of an ECG, or making a conclusion on a basis of
findings. Candidates rotate through a series of
“stations”, usually 12-20, and in a specified time
perform a standardized task.
The format of individual OSCE varies significantly.
Clinical models and standardized patients or
simulated patients can be used to allow large numbers
of students to be tested on the same clinical problem
without causing fatigue or stress to real patients.
Direct or indirect observations as well as checklists
and rating scales measure the performance against
predetermined standards resulting in a more objective
examination than with traditional methods. This
provides a more valid and more reliable examination
permitting the move away from testing factual
knowledge to testing a wide range of skills. The
variables of the examiner and the patient are, to a
large extent, removed. OSCE is particularly suited to
situations where a pass/fail decision has to be taken
and where a decision has to be made as to whether
a student has reached a prescribed standard. It is
cost-effective when many candidates are examined
at once, as it is difficult to create and administer and
requires resources and expertise. With succeeding
examinations, less time is required and both time and
effort can be reduced if a bank of objective test items
and checklists is maintained.
Use of OSCE for formative assessment has great
potential and value as the learners can gain insights
into the elements making up clinical competencies
as well as feedback on personal strengths and
weaknesses. However, in the OSCE, the student’s
knowledge and skills are tested in compartmentalized
fashion and he/she is not tested on the ability to look
at a patient as a whole being. Still, OSCE may be
combined with other forms of assessment, such as
the clerking of cases in the wards. The previously
used term for this assessment method was Multiple
Station Exercises/Exam (MSE).
Organ-Based Teaching
In this approach, medical competence is gained by
focusing on one organ system at a time. It is an
approach that integrates different disciplines
(subjects) such as biochemistry, physiology and
anatomy, and has ultimately led to the more common
problem-based approach, which is currently more
commonly used.
Outcome
All possible demonstrable results that stem from
casual factors or activities. In medical education,
outcome refers to a new skill, knowledge or stimulus
to improve the quality of patient care. Setting
outcomes can be very useful for developing a
framework of various results expected from various
educational activities. Outcomes may be related to
the educational process (process outcomes), to the
product of undergraduate medical education (learning
outcomes), or to the professional role of the physician
(performance outcomes).
Outcome-Based Education
This approach emphasizes educational outcomes
rather than the educational process and focuses on
the product of medical education such as what kind
of doctors will be produced, and with what professional
knowledge, skills, abilities, values and attitudes.
Educational outcomes must be clearly specified as
they determine the curriculum content, the teaching
methods, the courses offered, the assessment
process and the educational environment. The scope
and definition of competence and the levels of its
attainment is defined in terms of student development
within the natural progression in medical school.
Consequently, the assessment system will ensure that
the expected variation of levels of attainment is
defined and assessed. An example of such a
framework is the 12-outcomes paradigm of Dundee -
a model presented in the form of three-circles which
describes the following:
What the doctor is able to do: clinical skills;
practical procedures; patient investigations; patient
management; health promotion; disease
prevention and communication.
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Glossary of Medical Education Terms
How the doctor approaches his practice:
appropriate understanding of basic, social and
clinical sciences and underlying principles; with
appropriate attitudes and ethical understanding
and legal responsibilities and with the appropriate
decision-making skills and clinical reasoning and
judgment.
The doctor as a professional: understanding of the
doctor’s role within the health system and the
understanding of personal development.
In addition, some medical schools have already
incorporated advanced levels of progression in the
early phases of their curriculum such as problem-
based learning programs, early clinical exposure, and
self-directed learning programs.
Output
In the health field, this indicates the immediate result
of professional or institutional health care activities,
usually expressed as units of service such as patient
hospital days, outpatient visits or laboratory tests
performed.
Pan-American Federation of Associations of
Medicals Schools – (PAFAMS)
A non-governmental, academic and educational
organization that gathers information on medical
schools in the Western Hemisphere from Canada to
Argentina. Founded in 1962 in Chile, PAFAMS is
striving through collaboration toward the improvement
and development of innovative medical education.
The constituency is integrated by 12 national
Associations of Medical Schools, and comprises over
354 Medical schools. The mission is: “The promotion
and advancement of medical education and the
biomedical sciences in the Americas and the
Caribbean”.
http://www.fepafem.org.ve/
Patient Management Problem (PMP)
A written method that attempts to assess clinical
problem-solving abilities. To improve its validity, recent
improvements include an attempt to focus testing on
the key features within a clinical case, which
represents the diagnostic or problem-solving
challenge. The main advantage of this innovation is
that many more ‘clinical cases’ can be administered
to candidates in a given period of time than with
conventional PMP.
Computer-Based Patient Management Problem
(e-PMP) is a related method that has been used
for some years, which more recently has been
enriched with the ability to link computers to various
audiovisual inputs such as videodiscs and optical
holograms produced by lasers extending realism
of the simulations and conceivably providing
enhanced educational opportunities. The cost of
developing, establishing and maintaining the
required facility may constitute a significant
constraining factor for broader use.
Patient Surveys
Questionnaire used to assess patient satisfaction with
different aspects of their health care. The questions
address general aspects of the physician’s care such
as the amount of time spent with the patient, overall
quality of care, physician competency (skills and
knowledge), courtesy, and interest or empathy.
Specific patient care competencies can be assessed
including interpersonal and communication skills,
professional behavior, listening skills, provision of
information about examination findings, etc. Each
rating may generate a single score overall or separate
scores for different clinical care activities or settings.
Most patient satisfaction surveys are completed at
the time of service and require less than 10 minutes.
Improvements to this tool may include utilizing more
effective survey design and using computers to collect
and summarize survey data.
Peer Review or Peer Evaluation
Method for evaluating professional attitudes and
behavior, used by trainees to assess each other and
also used by supervisors, nurses and patients to
assess trainees. Typical measurement tools for this
form of testing are checklists and questionnaires.
Performance
Denotes what an individual actually does in a real life
situation. In medicine, it denotes what a student or
doctor actually does in an encounter with a patient
when applying learned knowledge and skills, mediated
by clinical judgment and the use of interpersonal
communication skills. From this standpoint,
competence implies professional maturity and ease
in making difficult decisions. And, although these
elements are inherent in good practice, it is not easy
to demonstrate them. Assessment of clinical
performance is of the greatest importance but is often
difficult to measure.
Performance-Based Assessment
An evaluation that demands trainees be engaged in
specified clinical activities. This permits evaluation of
an ability to perform clinical tasks and not merely the
recitation of medical knowledge. Typical
measurement tools for this form of testing are
checklists, observation logs, and anecdotal reports.
Personal Development Plan (PDP)
A list of educational needs, development goals and
actions and processes, compiled by learners and
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Glossary of Medical Education Terms
used in systematic management and periodic reviews
of learning. It is an integral part of reflective practice
and self-directed learning for professionals. It can be
equally valuable in teacher-directed medical training
for maintaining learner-centered approaches and
shared objectives. PDP can be used to manage
learning needs systematically, to set development and
performance improvement goals, organize learning
activities and review outcomes. Some educational
organizations accept completed plans for accredited
professional development and health managers link
them with appraisals.
Physician
A professional, qualified by education and authorized
by law to practice medicine. The essence of being a
professional is an ability to find solutions to difficult
problems for which there are no easily discovered
answers and to effectively handle medical situations
where no two patients are identical even if they have
the same condition. This differentiates the
professional, who must deal with complex problems
that tend not to have unambiguous, clear-cut
solutions, from the technician.
Population Health
Organized efforts focused on the health of defined
populations in order to promote and maintain or
restore health, to reduce the amount of disease,
premature death and disease-produced discomfort
and disability. Programs, services and institutions here
emphasize the prevention of disease and the health
needs of the population as a whole. Among a broad
scope of disciplines, various knowledge and skills are
utilized such as biostatistics, epidemiology, planning,
organization, management, financing and evaluation
of health programs, environmental health, application
of social and behavioral factors in health and disease,
health promotion, health education and nutrition.
Portfolio-Based Learning or Portfolios
A collection of evidence that learning has taken place,
usually set within agreed objectives or a negotiated
set of learning activities. Some portfolios are
developed in order to demonstrate the progression
of learning, while others are assessed against specific
targets of achievement. In essence, portfolios contain
material collected by the learner over a period of time.
They are the learner’s practical and intellectual
property and the learner takes responsibility for the
portfolio’s creation and maintenance. Because the
portfolio is based upon the real experience of the
learner, it helps to demonstrate the connection
between theory and practice, accommodating
evidence of learning from different sources, and
enabling assessment within a framework of clear
criteria and learning objectives. The use of portfolios
encourages autonomous and reflective learning which
is an integral part of professional education and
development. Candidates are expected to produce
evidence and process such evidence with relation to
a pre-determined standard. Since the portfolio
approach includes both content and a reflective
component, one must first determine which
components are to be assessed. Portfolios provide a
process for both formative and summative
assessment, based on either personally derived or
externally set learning objectives or a model for
lifelong learning and continuing professional
development.
Practicability of Assessment Procedures
As there are always restrictions on the resources
available to conduct assessments, expertise and
creativity are required to develop the best compromise
between ideal and practical procedures and tools for
assessment. Time and resources are required to
develop a proper examination possessing minimally
acceptable standards of validity and reliability. This
applies particularly to the assessment of clinical skills
where much longer or more frequent observations of
student performance are required than are usually
undertaken. The planning of exams should take into
account the number of students to be assessed. An
assessment procedure appropriate for 20 students
may not be practical where 100-200 have to be
evaluated. Important factors are the number of staff
available, their status and specialties, number of
available patients, available space or accommodation
and the end-use of the assessment; for instance, if
results are used to determine “pass or fail” status or
to probe for areas of competence in which students
are deficient.
Prevention
The goals of medicine are to promote health, to
preserve health, to restore health when it is impaired,
and to minimize suffering and distress. These goals
are embodied in the word prevention, which is easiest
to define in the context of levels, customarily called
primary, secondary and tertiary prevention:
Primary prevention refers to the protection of
health by personal and community wide effects,
such as preserving good nutritional status, physical
fitness, and emotional well-being, immunizing
against infectious diseases, and making the
environment safe.
Secondary prevention can be defined as the
measures available to individuals and populations
for the early detection and prompt and effective
intervention to correct departures from good
health.
Tertiary prevention consists of the measures
available to reduce or eliminate long-term
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Glossary of Medical Education Terms
impairments and disabilities, minimize suffering
caused by existing departures from good health,
and to promote the patient’s adjustment to
irremediable conditions. This extends the concept
of prevention into the field of rehabilitation. There
are no precise boundaries between these levels.
Preventive Medicine
A specialized field of medical practice composed of
distinct disciplines that focus on the health of defined
populations in order to promote and maintain health
and well-being and prevent disease, disability and
premature death. It aims at the application of
preventive measures within all areas of clinical
medicine. In addition to the knowledge of basic and
clinical sciences and the skills common to all
physicians, practitioners of preventive medicine
possess knowledge of and competence in other
disciplines. Among a broad scope of such disciplines
are: bio-statistics, epidemiology, planning,
organization, management, financing, and evaluation
of health programs, environmental health, application
of social and behavioral factors in health and disease,
health promotion, health education and nutrition.
Primary Health Care
The World Health Organization defines primary health
care as the principal vehicle for the delivery of health
care at the most local level of a country’s health
system. It is essential health care made accessible
at a cost the country and community can afford with
methods that are practical, scientifically sound and
socially acceptable. Everyone in the community
should have access to it, and everyone should be
involved in it. Beside an appropriate treatment of
common diseases and injuries, provision of essential
drugs, maternal and child health, and prevention and
control locally endemic diseases and immunization,
it should also include at least education of the
community on prevalent health problems and
methods of preventing them, promotion of proper
nutrition, safe water and sanitation.
Primary Medical Care
Primary medical care begins when a patient with a
new health problem encounters the first-level provider
of care. The provider initiates care, may screen for
referral to a specialist, and secures overall
responsibility for continuity of care provided by all
medical personnel in both outpatient and in-patient
settings.
Problem-Based Learning (PBL)
In this approach, students learn in small groups
supported by a tutor. They initially explore a
predetermined problem. The problem contains
triggers designed to evoke objectives or concepts
which are used to set the agenda for individual or
group investigation and learning after the initial
session. Subsequent group meetings permit students
to monitor their achievements and to set further
learning goals as required. The tutor’s role is to offer
support for learning and to help reach the expected
outcomes. PBL enables students to develop the ability
to translate knowledge into practice at an early stage,
encourages individual participation in learning and
also allows the development of teamwork skills.
Students in PBL courses have been found to place
more emphasis on “meaning” (understanding) than
“reproduction” (memorization). Students must engage
in a significant amount of self-directed learning;
lectures are kept to a minimum. PBL originated at
McMaster University in Canada, and then at
Maastricht University, and is now widely adopted in
medical schools in many countries. Each school
makes its own adjustments to the basic model. It does
require a heavy investment in resources (library
books, IT, tutorial rooms) as well as requiring
education and training for tutors.
Professionalism
Adherence to a set of values comprising both a
formally agreed-upon code of conduct and the
informal expectations of colleagues, clients and
society. The key values include acting in a patient’s
interest, responsiveness to the health needs of
society, maintaining the highest standards of
excellence in the practice of medicine and in the
generation and dissemination of knowledge. In
addition to medical knowledge and skills, medical
professionals should present psychosocial and
humanistic qualities such as caring, empathy, humility
and compassion, as well as social responsibility and
sensitivity to people’s culture and beliefs. All these
qualities are expected of members of highly trained
professions.
The American Board of Internal Medicine’s Project
Professionalism indicates the most important
elements of professionalism to be: altruism,
accountability, duty, excellence, honor and integrity,
and respect for others.
Professional Altruism: constitutes the essence of
professionalism and is based on the rule that the
best interest of patients and not self-interest is the
professional obligation.
Professional Accountability is an important
element of professionalism which is required of
physicians at several levels: to their patients for
fulfilling the implied contract governing the patient/
physician relationship, to society for addressing
the health needs of the public, and to their
profession for adhering to medicine’s time-honored
ethical precepts.
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Glossary of Medical Education Terms
Professional Duty can be expressed by the free
acceptance of a commitment to service, availability
and responsiveness when “on call,” accepting
inconvenience to meet the needs of ones patients,
enduring unavoidable risks to oneself when a
patient’s welfare is at stake, and advocating the
best possible care regardless of the patient’s ability
to pay. It is willingness to seek an active role in
professional organizations and volunteering ones
skills and expertise for the welfare of the
community.
Professional Excellence entails a conscientious
effort to exceed ordinary expectations.
Commitment to excellence is an acknowledged
goal for all physicians and includes a commitment
to life-long learning.
Professional Honor and Integrity implies being fair,
being truthful, keeping one’s word, meeting
commitments, and being straightforward. It also
requires recognition of the possibility of conflict of
interest and avoiding any situation in which the
interest of the physician is placed above that of
the patient or allowing personal gain to supersede
the best interest of the patient. It constitutes an
integral part of professionalism. The importance
of professionalism in the patient/physician
relationship cannot be overstated.
Professional Respect for Others is reflected in the
respect towards the patients and their families,
other physicians and professional colleagues such
as nurses, medical students, and residents. It is
the essence of humanism, and humanism is both
central to professionalism and fundamental to
enhancing collegiality among physicians.
Public Health
The combination of science, skills, and beliefs that is
directed to the maintenance and improvement of the
health of all the people through collective, organized
efforts of society to protect, promote, and restore
people’s health. The programs, services and
institutions involved emphasize the prevention of
disease and the health needs of the population as a
whole. Public health activities change with variations
in technology and social values but the goals remain
the same: to reduce the amount of disease, premature
death, and disease-produced discomfort and disability
in the population. Public health is thus a social
institution, a discipline, and a practice.
Quality Assurance
A system of procedures, checks, audits, and
corrective actions to ensure that all research, testing,
monitoring, sampling, analysis, and other technical
and reporting activities are of the highest achievable
quality. Quality assurance serves to benefit the quality
of care.
Quality of Care
A level of performance or accomplishment that
characterizes health care. Ultimately, measures of the
quality of care always depend upon clinical outcomes
or value judgments, but there are ingredients and
determinants of quality that can be measured
objectively, such as structure, process or procedures,
and outcomes.
Quality of Life
The degree to which individuals perceive themselves
as able to function physically, emotionally and socially.
In a general sense, it is that which makes life worth
living. In a more “quantitative” sense it refers to a
person’s time remaining alive, free of impairment,
disability, or handicap.
Reflective Learning Process
An important model of learning that is based on the
principle of gaining from the learner’s own experience;
this is significantly different from the traditional model
of undergraduate medical education. It has very clear
links with the model of self-directed learning based
on a portfolio which gives evidence of activity,
reflection and the outcomes of learning. Students use
their knowledge, skills and attitudes to solve problems
in the workplace. However, many problems are
ambiguous and create surprises. Recognition of these
surprises causes the student to review problems and
create alternative hypotheses, which is termed
“reflection in action”. This leads to a search for more
information, seeking help from colleagues or experts,
reading texts or searching on-line to solve the
problem. In order to turn the new information into new
learning, a further step is required, which takes place
after the problem has been solved: Reflecting on
action’ involves looking back critically over the initial
‘surprise’ and the resolution of the problem. The
process of reviewing and evaluating information leads
to learning and this in turn adds to expertise. The
process of learning itself tends to generate new
questions and motivates the professional to undertake
further inquiry, which results in the learning process
being determined more by the learner than by the
person who designed the activity. This process of
reflection provides a stimulus for learning and helps
learners to derive maximum benefit from their own
experiences.
Reliability
Trust in the accuracy or provision of one’s results; in
the case of tests, it is an expression of the precision,
consistency and reproducibility of measurements.
Ideally, measurements should be the same when
repeated by the same person or made by different
assessors. In tests, contributing factors to reliability
are the consistency of marking, the quality of test and
– 19 –
Glossary of Medical Education Terms
test items, and the type and size of the sample.
Satisfactory reliability of objective tests can be
achieved by having large numbers of well-constructed
test items marked by computer. Reliability is
characterized by the stability, equivalence, and
homogeneity of test.
Stability or test-retest reliability is the degree to
which the same test produces the same results
when repeated under the same conditions;
Equivalence or alternate-form reliability is the
degree to which alternate forms of the same
measurement instrument produce the same result
Homogeneity is the extent to which various items
legitimately team together to measure a single
characteristic, such as a desired attitude.
In a clinical examination, obtaining reliability depends
on three variables: the students, the examiners and
the patients. Such complexity makes it difficult to
reproduce a comparable situation for tests of clinical
skill and clinical problem-solving. In a reliable
assessment procedure, the variability due to the
patient and the examiner should be removed.
Wherever possible, a subjective approach to marking
should be replaced by a more objective one and
students should be tested by a number of examiners.
It is important to note that students are usually
examined using different patients, which may enhance
the performance of some students and harm the
performance of others. Therefore, tests which aim to
assess clinical skills and clinical problem-solving have
to contain many samples of student performance if
they are to achieve adequate levels of reliability. The
development of the multi-station objective structured
clinical examination (OSCE) represents an effort to
do so.
Reproducibility of Assessment
Consistency in producing the same results if a test is
repeated is a vital attribute of any test. It is important
to know that if the same examinees were given the
same test after some time and learned nothing in the
interim, the same scores would result. Reproducibility
is especially important in making licensure and
certification decisions.
Research
Scientific inquiry or an organized quest for new
knowledge and better understanding, such as of the
natural world or determinants of health and disease.
Research can take several forms: empiric
(observational), analytic, experimental, theoretical and
applied.
Residency
The period of training in a specific medical specialty.
It occurs after graduation from medical school and
its length varies from three to seven years, depending
upon the specialty.
Resident or Resident Physician
An individual at any level in a Graduate Medical
Education program, including subspecialty programs.
Other terms used to refer to these individuals include
interns, house officers, house staff, trainees, or
fellows. The term “intern” is often used to denote
physicians in their first year of training. The term
“fellow” is frequently used to denote physicians in
subspecialty programs (versus residents in specialty
programs) or in Graduate Medical Education
programs that are beyond the eligibility requirements
for first board certification in the discipline.
Risk Factor
An aspect of personal behavior or lifestyle,
environmental exposure, or inborn or inherited
characteristic, which on the basis of epidemiological
evidence is known to be associated with an
unfavorable health-related condition and considered
important to prevent, if possible. It is used as an
indication of increased probability of a specified health
outcome such as the occurrence of a disease but is
not necessarily a causal factor. The term risk factor
is further used to mean a determinant that can be
modified by intervention, thereby reducing the
probability of occurrence of disease or other specified
outcomes.
Science
A branch of knowledge that produces theoretical
explanations of natural phenomena based on
experimentation and observation.
Self-Assessment
The process of evaluating ones own deficiencies,
achievements, behavior or professional performance
and competencies. Self-assessment is an important
part of self-directed and lifelong learning because it
creates a need for improvement while it justifies
confidence in ones competence.
Self-Assessment Questionnaire (SAQ)
Assessment completed by the learner about him- or
herself to provide indirect, inexpensive measures of
skill attainment and real-life performance. SAQs serve
as an evaluation of ones own deficiencies and
achievements, professional behavior, performance
and competence. Though important as a tool in
motivation for improvement of competence, it has the
weakness of being subject to rating biases.
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Glossary of Medical Education Terms
Self-Directed Learning
A form of education that involves the individual
learner’s initiative to identify and act on his or her
learning needs (with or without assistance), taking
increased responsibility for his or her own learning.
Self-Empowerment
An event or process whereby an individual or group
gains control over decisions and actions affecting their
health.
Self-Referral
Ordering of laboratory tests, diagnostic procedures
or treatment for a patient by a physician from
businesses in which the physician has a financial
interest. Many physicians who have such financial
interests contend that their participation improves
access or quality of care, but results of a number of
studies suggest that physician-owned enterprises are
detrimental, promoting excessive use of diagnostic
tests and treatments and potentially increasing total
costs of health care as well as harming the physical
and financial well-being of the individual patient.
Short-Answer Questions
An assessment tool that requires students to construct
short, written answers to presented questions; often
used instead of multiple-choice questions to have
students actually recall the answer rather than merely
select it from a set of alternatives. As the answers
must be constructed, it is reasonable to assume that
there is little chance of guessing correctly. The
questions are therefore cued-recall measures of
memory for course material whereas multiple-choice
questions require only recognition. Although the stem
(question) could be the same in both exam formats
and the answer could be quite short, even a single
word, the short-answer version is likely to be more
difficult than the multiple-choice version. Because the
short-answer questions require students to construct
answers, they provide more information about the
students’ knowledge than the selection of a multiple-
choice alternative. The disadvantage of this form of
exam is related to grading. Question vagueness can
yield interpretive problems, and even with quite clear
questions, scoring requires assessors with relevant
knowledge, judgment and time.
Simulated Patient (SP)
Simulated patients are healthy persons who have
been trained to reliably reproduce the history and/or
physical findings of typical clinical cases. Sometimes
actors are used to accomplish this goal but more
often, health care providers are used. Use of an SP
is designed to assess students’ clinical skills while
making the examination as objective as possible. Note
that teaching an SP to simulate a new clinical problem
takes eight to ten hours.
Simulations and Models
Tools for assessment of clinical performance in an
environment closely resembling reality and imitating
real clinical problems to rate the examinees’
performance on clinical problems that are difficult or
even impossible to evaluate effectively without
harming a real patient. They permit examinees to
make life-threatening errors and provide instant
feedback so examinees can correct a mistaken
action.
Models are mannequins constructed to respond
realistically to actions, allowing examinees to
reason through a clinical problem without risk to a
real patient.
Simulation formats have been developed as paper-
pencil patient management problems (PMP),
computerized versions of PMP called clinical case
simulations (CCX), role-playing situations, e.g.,
standardized patients (SP), clinical team
simulations, anatomical models or mannequins,
and combinations of all of the above formats.
Virtual reality simulations (VR) use computers
sometimes combined with anatomical models to
mimic realistic organ and surface images and the
touch sensations a physician would expect
examining a real patient. Written and computerized
simulations have been used to assess clinical
reasoning, diagnostic plans and treatment for a
variety of clinical disciplines. They are expensive
to create.
Skill
The ability to perform a task well, usually gained by
training or experience; a systematic and coordinated
pattern of mental and/or physical activity.
Small Group Teaching
A very popular form of instruction since it permits the
working through of learning material, not just in terms
of knowledge but also in terms of attitudes. Within a
small group, participants are more likely to exchange
opinions and feelings. Usually such sessions are
structured with the help of specific exercises such as
patient interviews or discussion topics.
Standard
Refers to a model, example or rule for the measure
of quantity, weight, extent, value, or quality, established
by authority, custom or general consent. It is also
defined as a criterion, gauge or yardstick by which
judgments or decisions may be made. A meaningful
standard should offer a realistic prospect of
determining whether or not one actually meets it.
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Glossary of Medical Education Terms
Standards may be mandatory (required by law),
voluntary (established by private and professional
organizations and available for use), or de facto
(generally accepted by custom or convention, such
as standards of dress, manners, or behavior).
Standards in Education
A model design or formulation related to various
aspects of medical education and presented in a
manner that enables the assessment of graduates’
performance in compliance with generally accepted
professional requirements. They are set up by consent
of experts or by decision of educational authority.
Three types of interrelated educational standards can
be envisaged:
Content standards or curriculum standards
describe skills, knowledge, attitudes and values;
what teachers are supposed to “teach” and
students are expected to learn. Thus, the content
standards define what is to be taught and learned.
Content standards can be also defined as
“essential (core) requirements” that the medical
curriculum should meet to equip physicians with
the knowledge, skills and attitudes necessary at
the time of graduation.
Performance or assessment standards define
degrees of attainment of content standards and
level of competencies in compliance with the
professional requirements. Performance
standards describe how well content has been
learned.
Process or opportunity-to-learn standards define
availability of staff and other resources necessary
for the medical school so that students will be able
to meet content and performance standards.
A standard can be also classified four ways:
An absolute standard refers to the knowledge and
skills a student must possess in order to pass a
given course. An absolute standard stays the same
over multiple administrations relative to the content
specifications of the test. The failure rate may vary
due to changes in the group’s ability, from one
administration to the other.
A relative standard can be set at the mean
performances of the candidates, or by defining the
units of standard deviation from the mean. A
relative standard may vary from year to year due
to shifts in the ability of the group and may result
in a fixed annual percentage of failing students, if
the scores maintain a normal distribution across
administrations.
A norm-referenced standard is a standard based
on the representative group of the candidates’
population. Credentialing organizations may use
norm-referenced orientation, in which the standard
is based on the performance of an external large
representative sample (norm group) equivalent to
the candidates taking the test. The norm-
referenced standard will be somewhat unstable
and will shift according to the performance of the
norm group, as large as it may be. Shift of the
standard over time is a concern.
A criterion-referenced standard is a fixed standard
that may undergo periodic re-evaluation in view of
shifts or trends in candidates’ performance over
time. The criterion reference orientation links the
standard to the content of the level of competence.
Standardized Oral Examination (SOE)
A performance assessment using realistic patient
cases with a trained physician examiner questioning
an examinee in a standardized manner. These exams
assess clinical decision-making and the application
or use of medical knowledge with realistic patients.
The exam begins with the presentation of a clinical
problem in the form of a patient case scenario with a
request to the examinee to manage the case. An
examinee can be tested on a selection of different
clinical cases. The examiners need to be trained in
how to provide patient data for each scenario, how to
question the examinee, and how to evaluate and score
the examinee’s responses. To create such an exam,
extensive resources and expertise are required.
Standardized Patient (SP)
Individuals who have been trained to reliably
reproduce the history and/or physical findings of
typical clinical cases. They can be real patients who
have been “standardized” or they can be simulated
patients, i.e. persons who are not sick but take on a
patient’s history and role. Sometimes health care
providers or actors are used to accomplish this goal.
This tool is designed to make examination and
assessment of a student’s clinical skills as objective
as possible. To teach a standardized patient to
simulate a new clinical problem takes eight to ten
hours.
Standardized Patient Examination (SPE)
An exam used to assess history-taking and physical
examination skills, communication skills, differential
diagnosis, laboratory utilization, and treatment. A
standardized patient examination consists of multiple
standardized patients, each presenting a different
condition in a 10-12 minute encounter. The examinee
performs a history-taking and physical examination,
orders tests, provides diagnosis, develops a treatment
plan, and counsels the patient. Using a checklist or
rating form, the examiner or the Standardized Patient
evaluates the student’s performance and behavior.
Reproducible scores are readily obtained for history-
taking, physical examination, and communication
skills. Thorough training of raters, whether they are
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Glossary of Medical Education Terms
physicians, patients or other types of observers, is
critical to obtaining reliable scores. Development of
such an examination is often time-consuming.
Subject-Based Teaching
A method of teaching in which each subject area of
curriculum is addressed separately. In the past, this
model had been very prominent in basic science
education. Now, however, it is gradually being
replaced with a problem-based learning (PBL) where
knowledge and skills unfold as elements in cases that
illustrate real life situations.
Teacher-Centered Education
An educational system in which the teacher dictates
what is being taught and how it is to be learned. The
teacher is the central or key figure and activities such
as the formal lecture and the formal laboratory are
emphasized. Individual students have little control
over what they learn, the order in which they learn
and the methods they must use. In this approach,
learning is rather more passive than active. It is the
opposite of the learner-centered approach.
Telehealth
See Telemedicine.
Telemedicine
The application of communications technologies for
the provision of health care services (diagnosis,
treatment, prevention of diseases and injuries) over
spatial distance in a situation where remoteness and/
or availability of professional expertise is a critical
factor.
True-False Items Exam
An exam presenting statements for which students
are to choose one of two alternatives, true or false.
There are three general weaknesses of this testing
method which need to be recognized: a high level of
correct responses by chance, ambiguities regarding
statements’ truth status and varying criteria for
marking a statement “true”. However, there are
methods for addressing each problem:
First, because of the binary option, the formal
chance level of responding correctly is 50%. The
high rate of guessing correctly means that a
relatively large number of true-false items are
needed to allow for reasonable identification of
above-chance performance.
Second, the truth of some statements might be
ambiguous, subject to interpretation or dependent
on subtle aspects of the statement. To minimize
such problems, instructors should keep test
statements as clear-cut as possible.
A third problem concerns individual differences in
criterion for judging a statement “true” or “false”.
Students have varying degrees of confidence that
statements are true, so that two students having
the same feeling of “degree of truth” about a
statement, e.g. “85% true”, might well use different
criteria, with one marking the statement “true” and
the other “false”. To provide for maximum
discrimination, the test should be constructed so
that 50% of the statements are true and students
instructed to mark “true” the 50% of statements
that seem the most true to them.
An important advantage of this exam is that true-false
items are easy to construct, easy to score and can
cover any sort of content.
United States Medical Licensing Examination
(USMLE)
A 3-step examination procedure that provides a
common evaluation system for United States medical
licensure applicants. Results of the USMLE are
reported to State Medical Boards granting the initial
license to practise medicine. Each medical licensing
authority requires, as part of its licensing procedure,
a successful completion of an examination or other
certifications demonstrating qualification for licensure.
http://www.usmle.org/
Validity
A term that reflects a solid foundation or justification
for bringing the intended results. In the case of
assessment, validity means the degree to which a
measurement instrument truly measures what it is
intended to measure. The establishment of validity is
the first priority in developing any form of assessment.
Without it, all other attributes are of little consequence.
The assessment instrument should accurately
represent the skills or characteristics it is designed to
measure. Validity may be characterized in these four
ways − content, concurrent, predictive or criterion-
related validity:
Content validity is the one of greatest concern to
teachers as the test must contain a representative
sampling of the subject matter the student is
expected to have learned. This sampling must be
representative and should cross several categories
of competence, a range of patient problems and a
list of technical skills. Valid clinical examination
should assess the components of clinical
competence, including the ability to obtain from
the patient a detailed and relevant history; carry
out a physical examination of the patient; identify
the patient’s problems from the information
obtained and reach a differential diagnosis; identify
the appropriate investigations; interpret the results
of the investigations; recommend and undertake
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Glossary of Medical Education Terms
appropriate management including patient
education.
Concurrent validity considers the degree to which
a measurement instrument produces the same
results as another accepted or proven instrument
which measures the same parameters.
Predictive validity examines the degree to which
a measure accurately predicts expected
outcomes; for instance, a measure of attitudes
toward preventive care should correlate
significantly with preventive care behaviors.
Criterion-related validity includes concurrent
validity as well as predictive validity.
Value
A term referring to what people believe in, or what
they consider important about the way they live.
Values influence behavior and culture as persons,
groups and communities. Values therefore are an
important determinant of individual and community
health. They are, however, difficult to measure
objectively.
Variable
A quantity, attribute, phenomenon or event that may
assume any one of a set of values:
Independent variable refers to a characteristic
being observed or measured that is thought to
influence an event or manifestation (the dependent
variable) within the defined area of relationships
under study. In medical education, it is a factor
that could explain or predict the curriculum’s
outcomes such as the curriculum itself, previous
or concurrent training, environmental factors.
Dependent variable is a manifestation or outcome
whose variation we seek to explain or account for
the influence of independent variables. It can be a
program outcome, such as knowledge or skill
attainment, real-life performance, and clinical
outcomes.
It is prudent to focus on a few dependent variables
that are most relevant to the main evaluation
questions and similarly, to focus on the independent
variables that are most likely to be related to the
curriculum’s outcomes.
World Federation for Medical Education
(WFME)
A non-governmental organization with ties to WHO
and UNESCO, the WFME is concerned with global
education and training of medical doctors and is the
umbrella organization for six regional associations for
medical education. The WFME’s general objective is
to strive for the highest scientific and ethical standards
in medical education and to take initiatives with
respect to new methods, tools and management of
medical education. The central office has been
located at the University of Copenhagen, Denmark
since 1996, in collaboration with Lund University in
Sweden.
http://www.sund.ku.dk/wfme/
Written Interactive Test
Allows for assessment of clinical reasoning skills,
understanding and knowledge of clinical and basic
science and application of basic science to clinical
problems. Test methods such as essays and open-
ended interviews are used, providing information
about the respondent’s perceptions, attitudes,
feelings, and experiences. Examples of written
objective-type tests are MCQ, PMP, MEQ. Such test
should be designed to ensure that they are clinically
coherent, containing questions from different
disciplines, securing an appropriate discipline balance
and ensuring that questions and answers reflect
reasonable expectations of students. However, these
test methods are often subjective and may contain
rater biases. Presently, to enhance their validity and
reliability, most of above mentioned methods are
computerized with the addition of various audiovisual
and holographic inputs (computer-interactive tests).
– 24 –
Glossary of Medical Education Terms
