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Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 136-139

The unexplored value of “Normal”: A commentary on the lack of normal cases in high-stakes assessment

1 Post-Doctoral Fellow with the MacPherson Institute for Leadership, Innovation and Excellence in Teaching, Hamilton, Canada
2 Associate Professor with the Department of Medicine, Evidence and Impact, McMaster University, Hamilton, Canada
3 Associate Professor with the Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Canada

Correspondence Address:
Dr. Sandra Monteiro
David Braley Health Sciences Centre, McMaster University, 100 Main Street, 5th Floor, Hamilton ON L8P 1H6
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/amhs.amhs_106_21

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In this article, we highlight how standard assessments in the health professions pay little attention to “normal” cases – i.e. those without pathology – and as a result may be overlooking a skill that lies at the heart of efficient health care. The issue is explored with two overarching questions in mind: What specifically might be missed by excluding these normal cases from high-stakes assessment? And what broader implications does this have for medical practice? Drawing upon a large body of research on diagnostic expertise and clinical reasoning, we argue that accurate categorization of a case as either abnormal or normal represents a key diagnostic skill, and that this skill may be neglected in many standardized assessments because they consist almost entirely of abnormal cases. Unforeseen consequences of this structure are then discussed in terms of curriculum design and trainee perceptions. If discerning “abnormal versus normal” is as critical as the literature suggests, then perhaps our typical assessment strategies need to be re-evaluated. This under explored topic warrants further research.

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