Driving sustainable healthcare education through the development of assessment practices

Kathleen (Kay) Leedham-Green's picture

The GMC has recently announced that it requires all UK medical schools to ensure that graduating doctors are able to apply the principles of sustainable healthcare to their practice by 2020 [1]. There however is limited evidence on how to align assessment practices with this new learning outcome.

Assessment is known to drive both curriculum time and learning effort in medical education [2] therefore we arranged an assessment day for clinical educators, sustainable healthcare practitioners and assessment leads at medical schools, to design a range of assessments to support students in achieving this learning outcome.

The assessment day was organised by the Sustainable Healthcare Education Network across four UK regional hubs attended by sixteen clinicians, academics and educators from seven medical schools, linked through video conferencing.

Participants worked together to

a) review and discuss the principles and practices of sustainable healthcare, and the pedagogies that might support learning

b) write and review a set of single best answer (SBA) questions to Medical Schools Council Assessment Alliance (MCSAA) guidelines

c) create programmatic assessment ideas such as project work, assignments and research activities

d) generate clinical assessment ideas including OSCEs, PACES and work-place based assessments.

Participants demonstrated a range of conceptions of sustainable healthcare that included direct action on waste, low carbon swaps, and more indirect actions such as addressing the drivers of healthcare activity through health promotion, disease prevention and support for self-care. 

Participants criticised the current assessment paradigm in medical education, which was not felt to encourage criticality or creative approaches to complex problems. Participants contributed 27 multiple choice questions, with approximately half likely to meet the MSCAA standards for SBA questions. The most highly rated SBAs related to reducing the carbon footprint of healthcare activity through dry powder inhaler prescribing, appropriate use of anaesthesic gases, lifestyle medicine, medicines adherence and stopping medicines safely.

Suggestions for programmatic assessment items and project work included incorporating sustainability into quality improvement projects, community action projects, assignments relating to carbon foot-printing and value in healthcare, and critical evaluation of the drivers behind areas of over-treatment and over-prescribing.

Suggestions for clinical assessments such as OSCES/ PACES and work-placed based assessments included lifestyle medicine such as smoking cessation and dietary change; shared decision making in relation to vaccination/ screening and medicines starting/ stopping/ adherence; exploring and addressing the social determinants of health; and altering workplace based assessment templates so that they include the question “why has this person become sick and what can be done about that?”. The SBA questions will be submitted to MSCAA for consideration for national use.

Assessments and assignments are known to drive student learning. It is necessary to create assessment items that support and drive sustainable healthcare education. The current assessment paradigm within medical education was criticised for not supporting criticality or creative solutions to ‘wicked problems’. Programmatic assessment ideas and projects including quality improvement were felt to be the most appropriate modality for sustainable healthcare education assessments, however organisers were encouraged by creative ideas for SBA questions and clinical assessments.

1. GMC (2018). Outcomes for Graduates. London. https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/outcomes-for-graduates

2. Biggs (2003). Aligning Teaching for Constructing Learning. The Higher Education Academy. https://www.heacademy.ac.uk/system/files/resources/id477_aligning_teaching_for_constructing_learning.pdf

Dr Kathleen E Leedham-Green
Medical Education Fellow (Education Research)
MBBS, BSc, PG Cert APHE, MA Clin Ed, F HEA 
Medical Education Research Unit
Imperial College London

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