Answer to "How do you support learners?"


Editor: Sylvia Heeneman


Learners need to be supported in 3 areas:

1. the transition from a preceding (often) traditional assessment system to a curriculum using programmatic assessment

2. the provision, collection and use of meaningful information on their performance

3. the guidance of their self-direction of learning


For 1: Learners have often been embedded in curricula that uses a traditional assessment system and will have to get used to the theory and practice of programmatic assessment. Learners will need some form of instruction, what are the principles of programmatic assessment; how is it embedded in the curriculum; what are the data-points, assessment and feedback tasks in the curriculum; what is the principle of the high-stake decision moment? It is helpful to include learners of the next years in the curriculum to explain to novice learners how the principles of programmatic assessment work in practice. There is a limit to instruction and clarification, and an important step to ‘just’ learn and experience by ‘doing’. Learners will receive assessment and feedback information while progressing through the curriculum and experience what it means not to receive a ‘pass-fail’ decision on every assessment task. This ‘learning by doing’ will take time and guidance (by a mentor, see points 2 and 3) and it is important that this time is available. Give the learners time to experience how programmatic assessment works. This may take a full first assessment cycle, i.e. up to the first high-stake decision. This highlights the importance of having intermediate decisions in place, for the learners to experience the decision-making procedure and that the high-stake decision at the end of the cycle is not a surprise.


For 2, a system needs to be in place, that enables the provision, collection and use (see also point 3) of a wide range of assessment methods and meaningful narrative feedback. This is often facilitated by a portfolio (see also question 4,6, and 12). In addition, the assessment and feedback tasks need to be aligned with the intended learning outcomes (see question 3) and that needs to be transparent for the learners (also part of point 1). Meaningful narrative feedback on performance is an important element for learners to be able to support their learning (see question 5), thus feedback-givers need to be educated on the provision of rich narrative feedback. As feedback-givers are often peers as well as faculty, an education and training program for both learners and faculty has to be organized and provided (see also question 9). In addition, it needs to be kept in mind that more infrequent feedback of good quality is to be preferred over frequent feedback of poor quality. As the use and acceptance of feedback is dependent on the credibility of the feedback, the ‘‘less-is-more’’ principle needs to be applied.


For (3), a mentoring system is needed to guide and support the learners. It is well known that the provision of feedback on its own is not enough and a feedback dialogue needs to be in place. In addition, in a curriculum using programmatic assessment, learners will receive and collect multiple data points, i.e. assessment and feedback information on their performance (see also point 2). Learners will need to oversee the data, detect patterns, set learning objectives and self-direct their learning. There is a certain paradox that self-direction of learning needs direction. Therefore, in a dialogue with the mentor, performance is monitored, reflections shared and discussed, remediation activities planned, and follow-up of learning objectives can be overseen. As the curriculum and programmatic assessment are intertwined and span longer periods, it is advised that the mentoring system also is longitudinal, with the mentor and mentee working together for the duration of the program.


Of note, there are separate AskAMEE topics on ‘Portfolio’ and ‘Mentoring’, where additional information can be found.


For further reading:

  • Bok H, Teunissen P, Favier RP, Rietbroek N, Theyse L, Brommer H, Haarhuis J, van Beukelen P, van der Vleuten C, Jaarsma D. Programmatic assessment of competency-based workplace learning: when theory meets practice. BMC Medical Education 2013, 13:123.

  • Driessen E, van Tartwijk J, Govaerts M, Teunissen P, van der Vleuten C. The use of programmatic assessment in the clinical workplace: A Maastricht case report. Medical teacher 2012, 34:226-231.

  • Driessen E, Overeem K: Mentoring. In: Oxford textbook of medical education. Edited by Walsh K. Oxford, UK: Oxford University Press; 2013: 265-274.

  • Ginsburg S, van der Vleuten C, Eva K. The hidden value of narrative comments for assessment: a quantitative reliability analysis of qualitative data. Academic Medicine 2017, 92:1617-1621.

  • Hattie J, Timperley H. The power of feedback. Review of educational research 2007, 77:81-112.

  • Heeneman S, Oudkerk Pool A, Schuwirth L, van der Vleuten C, Driessen E. The impact of programmatic assessment on student learning: theory versus practice. Medical education 2015, 49:487-498.

  • Heeneman S, de Grave W. Tensions in mentoring medical students toward self-directed and reflective learning in a longitudinal portfolio-based mentoring system–An activity theory analysis. Medical Teacher 2017, 39:368-376.

  • Sambunjak D, Straus S, Marusic A. Mentoring in academic medicine: a systematic review. JAMA 2006, 296:1103-1115.

  • van der Vleuten C, Schuwirth L, Driessen E, Govaerts M, Heeneman S. Twelve tips for programmatic assessment. Medical teacher 2015, 37:641-646.

  • Watling C, Driessen E, van der Vleuten CPM, Vanstone M, Lingard L. Understanding responses to feedback: the potential and limitations of regulatory focus theory. Medical education 2012, 46:593-603.


Other papers/ reviews, next to review/ perspective papers by Cees and Lambert > perhaps with other questions:

  • Wilkinson T, Tweed M. Deconstructing programmatic assessment. Advances in Medical Education and Practice 2018:9 191–197

  • Hauer K, O’Sullivan P, Fitzhenry K, Boscardin C. Translating Theory Into Practice: Implementing a Program of Assessment. Acad Med. 2018, 93:444–450