Adding more assessments to a curriculum is one of the most common responses to a perceived learning gap — and it's an understandable one. More structured observations. More low-stakes quizzes. More checkpoints built into clinical rotations. If your students are struggling, more data seems like more opportunity to catch problems early and course-correct before it counts.
But frequency alone doesn't make assessment formative. And in medical education, where the gap between measuring learning and actually driving it can have significant downstream consequences for your students and their future patients, that distinction really matters.
Formative assessment vs. assessment for learning
Before getting into what makes assessment genuinely formative, it's worth addressing a question that comes up regularly in the literature: What's the difference between formative assessment and assessment learning (AfL)?
The short answer is that there isn't one, or at least, there shouldn't be. Both terms share the same central aim — using assessment evidence to guide instructional decisions and support learner improvement. Maintaining a strict separation between the two introduces unnecessary complexity and can result in fragmented implementation. The field is better served by treating them as functionally equivalent.
Throughout this series, formative assessment and assessment for learning are used interchangeably. Both refer to the ongoing, feedback-driven process through which assessment evidence is used to support learning in progress.
Anastasiya Lipnevich's article on how formative assessment actively cultivates learner competencies goes deeper on the foundational principles behind this approach and what they mean for practice.
What makes an assessment formative?
With that framing in place, the more practical question: What does it actually take for an assessment to function formatively?
Formative assessment is best understood not as a type of test or tool, but as a process, one that encompasses:
- establishing clear learning objectives
- employing diverse assessment methods
- providing actionable feedback
- adapting instruction based on gathered data
The formative nature of an assessment arises when educators actively use the data it generates to provide feedback, guide instruction and support student learning within a continuous and iterative feedback loop. Without that purposeful use, assessments risk being mislabeled as formative.
Four things have to work together for that loop to close.
Assessments should be continuous and regular.
Assessments should be administered not just at terminal checkpoints, but throughout a rotation, module, or program — in clinical scenarios, simulations, reflective exercises, peer interactions. Frequent, low-stakes assessment gives instructors and learners an ongoing read on where skills are developing and where they're stalling, well before difficulties compound. Critically, this isn't just a series of isolated tasks. It's a strategically planned sequence aligned with curriculum goals and focused on growth.
Assessments should be tightly aligned to learning objectives.
Your students can't work toward a target they can't see. When an assessment is explicitly connected to a specific competency — sharpening diagnostic reasoning, improving patient communication, refining a procedural technique — your learners understand what they're developing and why it matters. Competency-based frameworks like the ACGME milestones provide a useful structure here, establishing clear benchmarks that guide both educators and learners toward targeted professional growth.
Feedback should be actionable and timely.
This is where many well-designed formative assessment programs in medical education break down in execution. Feedback that arrives weeks after a clinical encounter or that identifies a problem without indicating a path forward gives learners little traction. Feedback is most effective when it is specific, anchored to observable behavior, connected to a learning objective and delivered at a point where your learner can act on it.
Instruction should adapt in response.
Assessment data that sits in a system without informing what happens next isn't functioning formatively. When a pattern of difficulty appears in an individual learner or across a cohort, something in the instructional approach needs to respond. This adaptive loop is what separates a formative assessment system from a monitoring system.
Why adding assessments isn't the same as making them formative
Consider a program that has embedded three additional observation checkpoints into a clinical rotation. Each generates a score. Faculty complete the form. Learners see the result. The data sits in a system.
On paper, this is formative assessment. In practice, it might not be; merely administering an assessment does not make it formative. If learners aren't receiving specific, actionable feedback, and if instructors aren't using the data to adapt their approach, those checkpoints are measuring learning rather than driving it. The infrastructure exists, but the function doesn't.
This helps explain a persistent gap in the field. Despite the recognized importance of formative practices in medical education, implementation often remains fragmented or overly reliant on traditional summative structures, even in programs that have nominally embraced formative assessment. 
What that means in practice
Shifting assessment from something that happens to your students to something that actively supports their learning means designing around what happens after the assessment, not just the assessment itself. For most programs, that means making some deliberate changes:
Building in structured time for feedback conversations
Combine foundational and clinical science questions to create tests that support a variety of curricular approaches
Ensuring learners understand what they're working toward before they're assessed on it
Responding when patterns of difficulty in student learning appear in assessment data by adjusting instruction
These changes don't have to happen all at once, but being intentional about each one is what moves assessment for measurement to assessment for learning. If you're working through what this looks like in practice with your faculty or program leadership, our on-demand webinar on assessment for learning is a good place to continue your exploration.
Up next
The next post in this series will pick up where this one leaves off, examining one of the most persistent sticking points in formative practice: why students often don't act on feedback, even when it's specific, timely and well-intentioned. Sign up for our mailing list to make sure you don’t miss it.