EFFECTIVENESS OF COMPETENCY-BASED ASSESSMENT VERSUS TRADITIONAL ASSESSMENT IN UNDERGRADUATE MEDICAL EDUCATION

Abstract

Background: Assessment processes are integral to the needs for achieving undergraduate medical students of knowledge, clinical skills, professional behavior, and decision making for independent practice. Traditional Assessment methods tend to be based on set and regular written/verbal/clinical assessments, while competency assessment focuses on real-life working, repeated evaluation, observation, feedback and demonstration of predefined competencies. The objective of this study was to compare competency-based assessment with traditional assessment among undergraduate medical students. Methods: A comparative study was conducted at Gomal Medical College, Dera Ismail Khan, from January 2025 to June 2025. Ninety-two undergraduate medical students were included, half of whom (46) were assessed using a competency-based method, and the other half (46) using the traditional method. Assessment results showed that general performance, written examination, clinical examination, workplace assessment, clinical reasoning skills, patient management, patient safety, patient satisfaction, clinical confidence and self-directed learning were the most commonly assessed items. Items that were most frequently assessed included general performance, written examination, clinical examination, workplace assessment, clinical reasoning skills, patient management, patient safety, patient satisfaction, clinical confidence, and self-directed learning. The data were analysed by SPSS version 25.0. Independent-samples t-test, chi-square test, Fisher's exact test and binary logistic regression were used appropriately. The criteria for statistical significance was defined as a p value of <0.05. Results: Students assessed through the competency-based approach achieved a significantly higher mean overall assessment score than those assessed traditionally (81.63 ± 6.42 vs. 75.28 ± 7.11, p < 0.001). Significant improvements were also observed in clinical examination performance, workplace-based assessment, clinical reasoning, clinical decision-making, procedural competence, communication, professionalism, teamwork, patient management, and patient-safety competencies. Feedback quality and student satisfaction were significantly greater in the competency based group. Satisfactory competency was achieved by 89.1% of students in the competency-based group compared with 67.4% in the traditional group (p = 0.012), while remediation was less frequent in the competency-based group (8.7% vs. 26.1%, p = 0.028). After adjustment for age, gender, and academic year, competency-based assessment remained independently associated with satisfactory competency achievement (adjusted OR = 3.68; 95% CI: 1.18 11.46; p = 0.025). Conclusion: Competency-based assessment was associated with better academic and clinical performance, stronger competency achievement, improved feedback, and greater student satisfaction compared with traditional assessment. Incorporating structured competency-based assessment into undergraduate medical education may support the development of clinical competence and provide a more comprehensive evaluation of student learning.