Measurement or Assessment in Health Education and its Type

Afza.Malik GDA

Formative and Summative Assessment  

Measurement or Assessment in Health Education and its Types

Assessment or measurement in health education includes Summative assessment and formative assessment their norms and criteria.


    Measurement is the process of assigning numbers to represent student achievement or performance, for instance, answering 85 out of 100 items correctly on a test. The numbers or scores indicate the degree to which a learner possesses a certain characteristic. Measurement is important for reporting the achievement of learners on nursing and other tests, but not all outcomes important in nursing practice can be measured by testing. 

    Many outcomes are evaluated qualitatively through other means, such as observations of performance in clinical practice or simulation. Although measurement involves assigning numbers to reflect learning, these numbers in and of themselves have no meaning. Scoring 15 on a test means nothing unless it is referenced or compared with other students' scores or to a predetermined standard. 

    Perhaps 15 was the highest or lowest score on the test, compared with other students. Or the student might have set a personal goal of achieving 15 on the test; Thus, meeting this goal is more important than how others scored on the test. Another interpretation is that a score of 15 might be the standard expected of this particular group of learners. To interpret the score and give it meaning, having a reference point with which to compare a particular test score is essential.

    In clinical practice, how does a learner's performance compare with that of others in the group? Did the learner meet the outcomes of the clinical course and develop the essential competencies regardless of how other students in the group performed in clinical practice? Answers to these questions depend on the basis used for interpreting clinical performance, similar to interpreting test scores.

Norm Referenced Interpretation

    There are two main ways of interpreting test scores and other types of assessment results: norm referencing and criterion referencing. In norm-referenced interpretation, test scores and other assessment data are compared with those of a norm group. Norm-referenced interpretation compares a student's test scores with those of others in the class or with some other relevant group. The student's score may be described as below or above average or at a certain rank in the class. 

    Problems with norm-referenced interpretations, for example, “grading on a curve,” are that they do not indicate what the student can and cannot do, and the interpretation of a student's performance can vary widely depending on the particular comparison group selected.In clinical settings, norm-referenced interpretations compare the student's performance with the performance of a group of learners, indicating that the student has more or less clinical competence than others in the group. 

    A clinical evaluation instrument in which student performance is rated on a scale of below to above average reflects a norm-referenced system. Again, norm-referenced clinical performance does not indicate whether a student has developed desired competencies, only whether a student performs better or worse than other students.

Criterion Referenced Interpretation

    Criterion-referenced interpretation, on the other hand, involves interpreting scores based on preset criteria, not in relation to the group of learners. With this type of measurement, an individual score is compared with a preset standard or criterion. The concern is how well the student performs and what the student can do regardless of the performance of other learners. Criterion-referenced interpretations may

    (a) describe the specific learning tasks a student can perform, for example, define medical terms;

   (b) indicate the percentage of tasks performed or items answered correctly, for example, define correctly 80% of the terms; other

    (c) compare performance against a set standard and decide whether the student met that standard, for example, met the medical terminology competency ( Miller et al., 2013). Criterion-referenced interpretation determines how well the student performed at the end of the instruction in comparison with the outcomes and competencies to be achieved.

    With criterion-referenced clinical evaluation, student performance is compared against preset criteria. In some nursing courses, these criteria are the objectives or outcomes of the course to be met by students. In other courses, they are the competencies to be demonstrated in simulation or clinical practice, which are then used as the standards for evaluation. 

    Rather than comparing the performance of the student with others in the group, and indicating that the student was above or below the average of the group, in criterion-referenced clinical evaluation, performance is measured against the outcomes or competencies to be demonstrated. The focus with criterion-referenced clinical evaluation is whether students achieved the outcomes of the course or demonstrated the essential clinical competencies, not how well they performed in comparison with the other students.


    Evaluation is the process of making judgments about student learning and achievement, clinical performance, employee competence, and educational programs, based on the assessment data. In nursing education, evaluation typically takes the form of judging student attainment of the outcomes of the course and knowledge gained in it, and the quality of student performance in the clinical setting. With this evaluation, learning needs are identified, and additional instruction can be provided to assist students in their learning and in developing competencies for practice. 

    Similarly, evaluation of employees provides information on their performance at varied points in time as a basis for judging their competence. Evaluation extends beyond a test score or performance rating. Brookhart and Nitko (2019) defined evaluation as the process of making a value judgment about the worth or quality of a student's performance or of products developed by students representing their learning. With evaluation, the teacher makes value judgments about learners: value is part of the word evaluation. 

    Questions, such as “How well did the student perform?” and “Is the student competent in clinical practice?” are answered by the evaluation process. The teacher collects and analyzes data about the student's performance, then makes a value judgment about the quality of that performance.

    In terms of educational programs, evaluation includes collecting information prior to developing the program, during the process of program development to provide a basis for ongoing revision, and after implementing the program to determine its effectiveness. With program evaluation, faculty members collect data about their students, alumni, curriculum, and other dimensions of the program for the purposes of documenting the program outcomes, judging the quality of the program, and making sound decisions about curriculum revision. 

    As educators measure outcomes for accreditation and evaluate their courses and curricula, they are engaging in program evaluation. Although many of the concepts described in this book are applicable to program evaluation, the focus instead is on evaluating learners, including students in all types and levels of nursing programs and nurses in healthcare settings. The term students are used broadly to reflect both of these groups of learners.

Formative Evaluation

    Evaluation fulfills two major roles: It is both formative and summative. Formative evaluation judges’ students' progress in meeting the desired outcomes and developing clinical competencies. With formative evaluation, the teacher judges the quality of the achievement while students are still in the process of learning (Brookhart & Nitko , 2019). 

    Formative evaluation occurs throughout the instructional process and provides feedback for determining where further learning is needed. With formative evaluation, the teacher assesses student learning and performance, gives students prompt and specific feedback about the knowledge and skills that still need to be acquired, and plans further instruction to enable students to fill their gaps in learning. 

    Considering that formative evaluation is diagnostic, it typically is not graded. The purpose of formative evaluation is to determine where further learning is needed. In the classroom, formative information may be collected by teacher observation and questioning of students, diagnostic quizzes, small-group activities, written assignments, and other activities that students complete in and out of class. These same types of strategies can be used to assess student learning in online courses.

    In clinical practice and other practice environments, such as simulation and skills laboratories, formative evaluation is an integral part of the instructional process. The teacher continually makes observations of students as they learn to provide patient care and develop their competencies, questions them about their understanding and decisions, discusses these observations and judgments with them, and guides them in how to improve performance. 

    With formative evaluation, the teacher gives feedback to learners about their progress in achieving the outcomes of practice and how they can further develop their knowledge and competencies.

Summative Evaluation

    Summative evaluation, on the other hand, is end-of-instruction evaluation designed to determine what the student has learned. With summative evaluation, the teacher judges the quality of the student's achievement in the course, not the progress of the learner in meeting the outcomes. 

    Although formative evaluation occurs on a continual basis throughout the learning experience, summative evaluation is conducted on a periodic basis, for instance, every few weeks or at the midterm and final evaluation periods. This type of evaluation is “final” in nature and serves as a basis for grading and other high-stakes decisions. 

    Summative evaluation typically judges broader content areas and competencies than formative evaluation. Strategies commonly used for summative evaluation in the classroom and online courses are tests, papers, other assignments, and projects. In clinical practice, rating scales, written assignments, e-portfolios, projects completed about clinical experiences, and objective structured clinical examinations (OSCEs) may be used. 

    Another strategy for summative evaluation is simulation, which can be used to assess students' decisions, skills, communication, team work, and other competencies. Both formative and summative evaluation are essential components of most nursing courses. However, because formative evaluation represents feedback to learners with the goal of improving learning, it should be the major part of any nursing course. By providing feedback on a continual basis and linking that feedback with further instruction, the teacher can assist students in developing the knowledge and skills they lack.

Evaluation and Instruction

    The intended learning outcomes are the knowledge, skills, and competencies students are to achieve. Following assessment to determine gaps in learning and performance, the teacher selects teaching strategies and plans clinical activities to meet those needs. This phase of the instructional process includes developing a plan for learning, selecting learning activities, and teaching learners in varied settings. The remaining components of the instructional process relate to evaluation. 

    Because formative evaluation focuses on judging student progress toward achieving the outcomes and demonstrating competency in clinical practice, this type of evaluation is displayed with a feedback loop to instruction. Formative evaluation provides information about further learning needs of students and where additional instruction is needed. Summative evaluation, at the end of the instruction, determines whether the outcomes have been achieved and competencies developed.

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