Competency-based medical education and the McNamara fallacy: Assessing the important or making the assessed important?

Abstract

The McNamara fallacy refers to the tendency to focus on numbers, metrics, and quantifiable data while disregarding the meaningful qualitative aspects. The existence of such a fallacy in medical education is reviewed in this paper. Competency-based medical education (CBME) has been introduced in India with the goal of having Indian Medical Graduates competent in five different roles - Clinician, Communicator, Leader and member of the health care team, Professional, and Lifelong learner. If we only focus on numbers and structure to assess the competencies pertaining to these roles, we would be falling prey to the McNamara fallacy. To assess these roles in the real sense, we need to embrace the qualitative assessment methods and appreciate their value in competency-based education. This can be done by using various workplace-based assessments, choosing tools based on educational impact rather than psychometric properties, using narratives and descriptive evaluation, giving grades instead of marks, and improving the quality of the questions asked in various exams. There are challenges in adopting qualitative assessment starting with being able to move past the objective-subjective debate, to developing expertise in conducting and documenting such assessment, and adding the rigor of qualitative research methods to enhance its credibility. The perspective on assessment thus needs a paradigm shift - we need to assess the important rather than just making the assessed important; and this would be crucial for the success of the CBME curriculum.