Programmatic assessment of competency-based workplace learning: when theory meets practice.

BACKGROUND: In competency-based medical education emphasis has shifted towards outcomes, capabilities, and learner-centeredness. Together with a focus on sustained evidence of professional competence this calls for new methods of teaching and assessment. Recently, medical educators advocated the use of a holistic, programmatic approach towards assessment. Besides maximum facilitation of learning it should improve the validity and reliability of measurements and documentation of competence development. We explored how, in a competency-based curriculum, current theories on programmatic assessment interacted with educational practice. METHODS: In a development study including evaluation, we investigated the implementation of a theory-based programme of assessment. Between April 2011 and May 2012 quantitative evaluation data were collected and used to guide group interviews that explored the experiences of students and clinical supervisors with the assessment programme. We coded the transcripts and emerging topics were organised into a list of lessons learned. RESULTS: The programme mainly focuses on the integration of learning and assessment by motivating and supporting students to seek and accumulate feedback. The assessment instruments were aligned to cover predefined competencies to enable aggregation of information in a structured and meaningful way. Assessments that were designed as formative learning experiences were increasingly perceived as summative by students. Peer feedback was experienced as a valuable method for formative feedback. Social interaction and external guidance seemed to be of crucial importance to scaffold self-directed learning. Aggregating data from individual assessments into a holistic portfolio judgement required expertise and extensive training and supervision of judges. CONCLUSIONS: A programme of assessment with low-stakes assessments providing simultaneously formative feedback and input for summative decisions proved not easy to implement. Careful preparation and guidance of the implementation process was crucial. Assessment for learning requires meaningful feedback with each assessment. Special attention should be paid to the quality of feedback at individual assessment moments. Comprehensive attention for faculty development and training for students is essential for the successful implementation of an assessment programme.

Effect of show jumping training on the development of locomotory muscle in young horses.

OBJECTIVE: To investigate whether training for show jumping that is commenced early after birth affects the characteristics of equine locomotory muscle. ANIMALS: 19 Dutch Warmblood horses. PROCEDURES: Horses were assigned to a trained or not trained (control) group. After weaning, training (free jumping [2 d/wk] that was alternated with a 20-minute period of exercise in a mechanical rotating walker [3 d/wk]) was started and continued until horses were 3 years old. Fiber type composition (determined from myosin heavy chain [MyHC] content), fiber area, diffusion index (area supplied by 1 capillary), citrate synthase activity, and Na(+),K(+)-ATPase content were assessed in gluteus medius muscle specimens collected at 0.5, 1, 2, and 3 years. RESULTS: Developmental changes included an increase in MyHC fiber type IIa and a decrease in type IIad; increases in fiber area, diffusion index, and citrate synthase activity; and a decrease in Na(+),K(+)-ATPase content. The MyHC fiber type I and type IId were detected in high and low proportions, respectively. Training increased Na(+),K(+)-ATPase content, but did not affect other variables. CONCLUSIONS AND CLINICAL RELEVANCE: In horses, show jumping training at an early age resulted in increased Na(+),K(+)-ATPase content of the deep portions of the gluteus medius muscle. The lack of training effects on the other muscle characteristics can partly be explained by the fact that an appropriate (aerobic) fiber type composition was already established at training commencement. These data also suggested that the developmental changes in equine muscle represent sufficient adaptation to meet the demands of this specific training.

Effect of exercise on development of capillary supply and oxidative capacity in skeletal muscle of horses.

OBJECTIVE: To determine whether postnatal development of oxidative capacity and capillary supply of skeletal muscle is affected by various movement regimens in horses. ANIMALS: 35 foals. PROCEDURES: Dutch Warmblood foals were allocated into 3 groups (box stall rest, box stall rest with training, and free pasture exercise). Training comprised an increasing number of gallop sprints from 1 week after birth to 22 weeks of age. From 22 to 48 weeks, the 3 groups were combined and allowed to exercise freely. Capillary supply (diffusion index [ie, area supplied by 1 capillary]), citrate synthase (CS) activity, and succinate dehydrogenase (SDH) activity were measured in biopsy specimens of deep gluteus medius muscle. RESULTS: During the first 22 weeks, diffusion index increased in all 3 groups (the training and pasture groups had a smaller increase, compared with the box stall rest group), total SDH activity increased in the training and pasture groups and decreased in the box stall rest group, and CS activity decreased in all groups. The effect of the various movement regimens on the diffusion index remained after the groups were combined. CONCLUSIONS AND CLINICAL RELEVANCE: Withholding of exercise had a negative effect on the capillary supply (ie, diffusion index increased) that remained after box stall rest was discontinued and on oxidative capacity. Box stall rest with training prevented the negative effects and eventually had the same positive effect as pasture exercise.