Shaping the right conditions in programmatic assessment: how quality of narrative information affects the quality of high-stakes decision-making

Lubberta H de Jong, Harold G J Bok, Lonneke H Schellekens, Wim D J Kremer, F Herman Jonker, Cees P M van der Vleuten

Research output: Contribution to journalArticleAcademicpeer-review


BACKGROUND: Programmatic assessment is increasingly being implemented within competency-based health professions education. In this approach a multitude of low-stakes assessment activities are aggregated into a holistic high-stakes decision on the student's performance. High-stakes decisions need to be of high quality. Part of this quality is whether an examiner perceives saturation of information when making a holistic decision. The purpose of this study was to explore the influence of narrative information in perceiving saturation of information during the interpretative process of high-stakes decision-making.

METHODS: In this mixed-method intervention study the quality of the recorded narrative information was manipulated within multiple portfolios (i.e., feedback and reflection) to investigate its influence on 1) the perception of saturation of information and 2) the examiner's interpretative approach in making a high-stakes decision. Data were collected through surveys, screen recordings of the portfolio assessments, and semi-structured interviews. Descriptive statistics and template analysis were applied to analyze the data.

RESULTS: The examiners perceived less frequently saturation of information in the portfolios with low quality of narrative feedback. Additionally, they mentioned consistency of information as a factor that influenced their perception of saturation of information. Even though in general they had their idiosyncratic approach to assessing a portfolio, variations were present caused by certain triggers, such as noticeable deviations in the student's performance and quality of narrative feedback.

CONCLUSION: The perception of saturation of information seemed to be influenced by the quality of the narrative feedback and, to a lesser extent, by the quality of reflection. These results emphasize the importance of high-quality narrative feedback in making robust decisions within portfolios that are expected to be more difficult to assess. Furthermore, within these "difficult" portfolios, examiners adapted their interpretative process reacting on the intervention and other triggers by means of an iterative and responsive approach.

Original languageEnglish
Article number409
Pages (from-to)1-10
JournalBMC Medical Education
Issue number1
Publication statusPublished - Dec 2022


  • Competency committee
  • Feedback
  • High-stakes decision-making
  • Portfolio
  • Programmatic assessment
  • Reflection
  • Validity


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