Health equity is the goal of medical education: Implications for assessment validity

INTRODUCTION: Prevailing health inequities, viewed as a matter of social justice, have catalysed an intentionality about ensuring that medical graduates can contribute to more equitable health outcomes. Medical education programmes are grappling with what this means for the assessment imperative. Attention has been given to criteria for judging assessment quality, with validity remaining an important criterion. In this paper, we explore the implications of health equity for validity and ask whether plans of assessment that do not provide evidence of students' capacity to act to advance health equity can be considered valid. HEALTH EQUITY AS A CONSIDERATION IN ASSESSMENT: We align with calls for medical education curricula and their assessment plans to fulfil medicine'ssocial contract to respond to societal health needs. We suggest that such a commitment requires us to explicitly address health equity and the inequitable health outcomes experienced by patients and communities. In turn, it challenges us to reflect on what addressing these inequities might mean for the validity and interpretation of the inferences we make from our assessments. RECONSIDERING ASSESSMENT VALIDITY THROUGH A HEALTH EQUITY LENS: Drawing on scholarship related to assessment validity, health equity and social justice, we identify conceptual and practical challenges associated with foregrounding health equity as a central component of assessment validity. Using a health equity lens, we propose a set of heuristic prompts spanning purpose, constructs, evidence, inferences, learning effects, context, stakeholders, and systems and structures. These prompts are intended to foster critical reflection on how current understandings of assessment validity might be broadened when advancing health equity is recognised as a core goal of medical education. CONCLUSION: Rather than offering definitive solutions, we seek to provoke dialogue about the consequences for our students and society when we do not embrace considerations of health equity in our programmes of assessment. We contend that if medical education is committed to advancing health equity, assessment of our students cannot be deemed valid unless it provides evidence to support decisions on their ability to act towards health equity.