How integrated are the Vertically Integrated Assessments (VIA) in medical education?

Introduction/background: Vertical integration is increasingly being incorporated in medical education to prepare graduates better for clinical practice. Vertically integrated assessments (VIA) are designed to assess the integration of early clinical education, biomedical sciences and clinical responsibility levels for trainees. A paucity of literature is evident of its efficiency. Aim/objectives: The aim of the present study is to assess efficiency of VIA through comparison of learner’s performance between VIA and non-VIA assessments. Methods: Data on 1188 medical students enrolled during 2013 to 2017 were analysed using Blunt-Altman measure of agreement. The agreement between the assessment modality scores with-VIA and without-VIA were illustrated using a Bland-Altman plot; 95% limits of agreement for each comparison (average ± 1.96 standard deviation of difference) were computed. The difference between the estimates was regressed on the average of the 2 estimates. Proceedings of the Australian & New Zealand Association for Health Professional Educators 2019 Conference Results: The learner’s performance scores with-VIA and without-VIA exhibited significant disagreement in both pre-clinical (β = -8.9; 95%CI -9.6, -8.3 p<0.01) and clinical (β = -34.3; 95%CI -35.6, -33.0 p<0.01) assessments, suggesting generalized underestimation without vertical integration. The disagreement is more apparent in students with the higher grades. Discussion: This study finds significant discrimination between assessment modalities with and without vertical integration. The greater discrimination in the former implicates better performance differential of in high achievers. Conclusions: VIA is efficient in determining performance differential among medical students, the efficiency of VIA increases with increasing student grade.