Work-based Assessment Programs for #MedEd (Part 1)

(This is the first of a two part series that describes a CBME work-based assessment program. Details on the McMaster Modular Assessment Program (McMAP) are here and are available free for a short time until the publisher moves the manuscript from on-line to print version. To download the free iBooks, click here for the junior version, here for the intermediate version and here for the senior version. –Jonathan (@sherbino))

By Teresa Chan (@TChanMD)

It was at the Wilson Centre Atelier on Qualitative Methods when I was first encouraged to journal about my experience in the liminal space.  The advice I received was that you should create artifacts to help recall your experiences in the liminal space, once your career has progressed.

I think that this advice is akin to the reading I have done in the area of Design Thinking.  One of the major ideas in the design thinking movement (which is washing over Silicon Valley right now) is  the idea of empathy for your end user.  This is the story of my personal case study in this area.

A Personal Experience with Liminality & Educational Design

An example from my own life is my experience with the McMaster Modular Assessment Program (McMAP).  In PGY4, during my fellowship in medical education, I was approached by my program director to help with re-inventing our daily assessment system.  At this point, we had a form that consisted of 8 x 10-point global CanMEDS rating scales (i.e. Rate this resident on the Communicator Role on a scale from 0-10) that did not have behavioural anchors and used a normative scale.  Needless to say, I did not find these sheets very useful as a learner, and as a result, I quickly agreed to take on the task as a member of a two-person “subcommittee.”

Taking some time to perform a needs assessment, and reflecting on my own experience, I determined that there was an opportunity to redesign a system that might ‘force’ focused, high-quality, formative feedback from my faculty members.  In essence, to create a system that created the environment, by scaffolding faculty member observations and discussions.

As I reflect on this experience, I realize that a big part of my advantage was my proximity to the junior learners for which I was designing the system.  I had been in their positions just a mere 2 years prior… and in addition to this, I now had the distance from their particular positions to know what might be beneficial to have prepared me for transitioning to a senior resident.

I would later have the same perspective when designing the senior assessment system, while I was a junior attending. In both situations my position in that liminal space afforded me insights into the particular issues experienced by the learners I was working for.

In my estimation, it is my time and work in this area that has most developed my skills as a Clinician Educator – the politics and logistics of developing and implementing McMAP helped develop my abilities to negotiate and work with large groups of collaborators; and the background reading I did gave me a great and deep understanding of core medical education content areas (competency-based medical education and workplace-based assessment).


In my experience, your ability to walk in the shoes of those for whom you design is a key concept. I think liminality lends itself to a transitional state that creates this ability to reflectively and reflexively observe your previous state as you begin to ‘leave it behind,’ thereby affording you a glimpse of something you didn’t see before.