This post is the third in a five-part series drawing on Formative Assessment and Feedback in Medical Education: A Practical Guide, AMEE Guide No. 189. Each post will take a question medical educators are actively grappling with and work through what the research and the practice actually suggest.
Written and multiple-choice exams can tell you a great deal—whether a student has mastered foundational knowledge, can apply clinical reasoning to a complex case, or is ready to move to the next stage of training. These tools are scalable and reliable. But they're also just one instrument in a larger system.
Not every competency can be accurately assessed the same way, and a program that leans heavily on any one format risks missing vital parts of the picture.
Earlier in this series, we looked at what makes an assessment truly formative and why feedback doesn’t always lead to real change. Now, let’s talk about assessment strategy. The big question: Which methods actually show how a student is growing and learning? And once you pick those methods, are you using them effectively?
There’s rarely one "right answer." Using a mix of written assessments, peer evaluations, simulations, structured clinical exams, and verbal feedback gives your students more ways to grow—and provides a clearer picture of their progress.
The power of peer assessment
Peer assessment is sometimes underestimated. It isn’t just a way to save faculty time. When students give feedback to each other, they don’t just help their classmates—they sharpen their clinical thinking, learning to spot gaps in reasoning and articulate why one approach is stronger than another. Giving strong feedback is just as valuable to the learner as receiving it.
The key is structured peer assessment with clear guidelines. Rubrics and clear definitions of competency give students a concrete framework that helps them advance instead of defaulting to vague, less helpful comments like "This is good." What really matters isn’t how you pair the students—it’s how you teach the process so their time isn’t wasted.
Simulation: where feedback meets the real world, without real-world risk
Understanding the steps of Advanced Cardiac Life Support is a world away from executing them under real-world pressure when a team is watching. Simulation lets students make mistakes and improve while there’s still room for error. High-fidelity scenarios give you a window into students’ technical skills, clinical judgment, and those crucial non-technical skills like communication and team coordination, all at once.
The most significant learning happens in the debrief, where a complex experience becomes a durable lesson. The debrief is what turns the scenario into formative assessment in medical education, because it helps students interpret what happened and decide what to do differently next time.
Standardized patient encounters bring simulation into real-time interactions, such as delivering bad news, getting a history, or counseling on a difficult lifestyle or medication change. That dual perspective, from both the standardized patient and the supervising faculty, often highlights performance areas that neither would catch on their own.
And now, AI-driven simulation provides an emerging layer that can adapt dynamically to a learner’s performance and offer immediate, data-driven feedback in a controlled, risk-free environment. Our new Communication Learning Assessment (CLA) is one example—a digital, app-based formative tool with realistic, video-based patient scenarios to improve communication skills before the first clinical encounter. It pairs each scenario with guided reflection and feedback so students can identify strengths, close gaps, and build confidence.
A good OSCE does more than tick boxes
Objective Structured Clinical Examinations (OSCEs) stand out as one of the strongest ways to evaluate more complex, nuanced competencies like clinical reasoning, physical examination technique, and patient communication. A well-constructed OSCE station does more than simply capture whether a student ticks all the boxes on a checklist. It shows how they integrate patient history, physical findings, and diagnostic reasoning into a complete clinical picture.
The real value comes when the feedback goes beyond checklist items, exploring what the student understood and why they chose certain decisions. When you design OSCEs for formative purposes, they don’t just measure competence. They help build it. A good OSCE should do more than score specific actions; it should show how the learner reasons in the moment.
Auditing your assessment methods. Are key competencies being checked before the high-stakes final?
Making sure your debrief structure is doing as much work as the simulation or OSCE scenario.
Building peer assessment into existing activities. Giving good feedback is a clinical skill, too.
Pairing written and verbal feedback intentionally. A brief follow-up conversation increases the likelihood feedback gets used.
The goal isn’t complexity for its own sake. It’s giving your students and yourselves the evidence and the opportunities needed to make formative assessment in medical education useful.
Up next
The next post in this series turns to those delivering these assessments—examining what effective formative assessment in medical education asks of educators that traditional evaluation never has, and what it means to move from evaluator to coach. Sign up for our mailing list to make sure you don’t miss it.