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This perception was due to assessments being recorded in the portfolio and used for summative decisions and it was reinforced by the generally low quality of the feedback.
Our study raises the question whether there is a link between our findings on reliability and the subsequent summative decisions on clinical performance.
A programme of assessment with low-stakes assessments providing simultaneously formative feedback and input for summative decisions proved not easy to implement.
The fact that all data points ultimately contributed to the final summative decisions caused students to perceive all individual assessments as summative rather than formative.
Students preferred expert feedback over peer feedback because experts represent the performance standard for summative decisions, which is obvious, because students depend on their judgment.
Recent work on different aspects of a portfolio approach to competency-based assessment has reported the value of giving students the responsibility of 'interpreting, selecting and combining formative assessments received during the year, to document their performance in a learning portfolio for summative decisions' [ 28- 30].
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The diagnosis is a summative decision, developed from key information.
In other words, when performance improvement influences reliability, it should be incorporated in summative decision making.
They expressed a desire to enter a pass/fail judgement on the assessment form and were unhappy that they had no influence over the weighing of individual assessments in the ultimate summative decision.
The primary objective of the intermediate evaluation was to provide students feedback on longitudinal competency development to be used to formulate new learning goals to prepare for the final (high-stakes) evaluation leading to a summative decision (go/no go).
The mean of all global ratings was taken as the overall judgement; this overall judgement was used in summative pass/fail decisions per clerkship.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com