How are formative assessment methods used in the clinical setting? A qualitative study

Objective: To explore how formative assessment methods are used and perceived by second-year junior doctors in different clinical settings. Methods: A focused ethnography study was carried out. Ten second-year junior doctors from different specialties were selected using purposive sampling. The junior doctors were observed during a day in their clinical workplace where formative assessment was in focus. They were subsequently phone interviewed using a semi-structured interview guide regarding their experiences and attitudes towards formative assessment. Field notes from observations and interview transcriptions were analyzed using an inductive content analysis approach, and the concept of "everyday resistance" was used as a theoretical lens. Results: Three themes were identified: First, there were several barriers to the use of formative assessment methods in the clinical context, including subtle tactics of everyday resistance such as avoidance, deprioritizing, and contesting formative assessment methods. Secondly, junior doctors made careful selections when arranging a formative assessment. Finally, junior doctors had ambiguous attitudes towards the use of mandatory formative assessment methods and mixed experiences with their educational impact. Conclusions: This study emphasizes that the use of formative assessment methods in the clinical setting is not a neutral and context-independent exercise, but rather is affected by a myriad of factors such as collegial relations, educational traditions, emotional issues, and subtle forms of resistance. An important implication for the health care sector will be to address these issues for formative assessment methods to be properly implemented in the clinic.