Undergraduate medical education, with very rare exception, is divided into discrete courses, each dealing with a specific subject area, such as physiology, physical diagnosis, or pediatrics. Characteristically, our assessment of student achievement relies heavily upon examinations based on these courses. There are two aspects of this practice to which I will focus our attention: (1) some of the educational implications of compartmentalizing our instruction and evaluation into "courses" and (2) the consequences of basing our assessments of students largely on formal examinations. Both of these matters lead into the larger questions of what it is that we want students to learn and how we can best assure ourselves that they have learned.
Meanings of Course Examinations
In the final course examinations which we administer, we are knowingly or unknowingly saying to the students, "This is a sampling of the central issues you were to have derived from our instruction; this