Tracing Philosophical Shifts in Health Professions Assessment

Assessment of clinical competence continues to challenge the health professions, leading educators and researchers to seek new solutions to long existing and newly identified problems. Broadening definitions of competence, increasing complexities of practice, the valuing and devaluing of some features of assessment, newly identified limitations in the way assessment is enacted, and much more, provide ongoing stimuli for advancement and change. In most assessment contexts, philosophical positions play a fundamental role, yet they are too-often left implicit. In this chapter, we explore philosophical positions and shifts that have influenced assessment practices in health professions education. Our aim is to describe how shifts in perspective have informed health professional assessment and to outline their consequences. We offer that because reflecting on the relationship between philosophical positions and assessment science provides opportunities and mechanisms through which miscommunication and insufficient practice might be resolved. That is, we hope this chapter prompts health professional educators to identify and critically examine their guiding assumptions, commitments, and intellectual frameworks. Through applied philosophy, the field can re-examine and reformulate existing and future strategy in a manner that can allow complex assessment challenges to be approached in ways that enable practical issues to be more deeply understood and advanced.