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Universities should ensure their assessments are sound and defendable

18 August 2025 | Story André Damons | Photo André Damons

Universities have an obligation to ensure that their assessments are sound and defendable when they confer degrees for professional qualifications, such as in medicine. Can institutions confidently defend these results and what are the implications if they pass a student who is not competent?

These were some of the questions Prof Hanneke Brits, a family medicine specialist at the Free State Department of Health, as well as the Department of Family Medicine, at the University of the Free State (UFS), addressed during her inaugural lecture on Tuesday (12 August). The UFS, she concluded at the end of her lecture, titled To pass or not to pass: Can we confidently defend the outcome of our assessments? can defend its clinical assessments with the implementation of effective workplace-based assessment and trained examiners.

The implications of passing incompetent students

According to Prof Brits, who has supervised numerous undergraduate and postgraduate student research projects, she chose this topic because decisions have consequences. She gave an overview of the assessments in the clinical years of the undergraduate medical programme. In so doing, she also answered other questions including what may happen when universities pass students who are not competent and what may happen if they fail competent students. When the university passed a candidate, she said, that candidate may register with a professional body like the Health Professions Council of South Africa to work as a doctor.

“What are the implications if we fail to fail a student who is not competent? The implications are that patients may suffer if they are treated by an incompetent doctor, which may lead to the doctor running into trouble if it is found that their work is not up to standard. This may further lead the faculty being labelled as poor for training substandard doctors.

“The throughput rate of the university may go down and the university may not get subsidy for the students. The student must repeat his module with a lot of emotional and financial burden. They public may suffer because there are not enough healthcare professionals to treat them. Therefore, we must get this right,” she said.

When assessing students, assessors should start at the bottom: students should know, then they should know how, then they should show how and then they must do. All assessments should meet the basic requirements of validity, reliability, fairness, educational impact and feasibility, explains Prof Brits.

Workplace-based training and assessment

During her PhD study, she looked specifically at assessments in the clinical years of the undergraduate medical programme. “It is quite complicated,” said Prof Brits, “to do assessment for professional qualifications as you need to obey to the rules and regulations of the Department of Education, the Department of Health, the Health Professions Council of South Africa, the Colleges of Medicine of South Africa because they are our examining body, as well as our own university rules and international assessment guidelines and best practices.”

She compiled a framework to measure what they do at the UFS and found that the decision reliability was excellent – meaning the students that passed during the year passed at the end of the year and those that failed, failed. The reliability of some of the methods used for the final assessment was not good, however, if more assessments with supplementary exams were included, it was better.

The conclusion of her study was that the UFS mostly complied with the regulations of the regulatory bodies. The recommendation from this study was to implement workplace-based assessment (WBA) to improve both the validity and reliability of assessments and to make it more defendable. Prof Brits explained that WBA is where students get regular assessment and feedback while they work and receive training in hospitals or clinics. “For example, the student is seeing a patient in the emergency department who was stabbed with a knife on his hand. Is the student able to assess the severity, can the student manage the wound and what about follow-up?

“The advantage of WBA is that we train in real life situations and manage conditions that occur commonly. In real life situations, students use many senses while learning, e.g., seeing, hearing, touching, smelling, which all enhance knowledge retention. It is important that students receive feedback and that we document these encounters. To ensure a holistic approach to the management of patients we use Entrustable Professional Activities or EPAs – something that I can trust a person to do. It is a combination of knowledge, skills and attitudes.”

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“To forgive is not an obligation. It’s a choice.” – Prof Minow during Reconciliation Lecture

2014-03-05

“To forgive is not an obligation. It’s a choice.” – Prof Minow during the Third Annual Reconciliation Lecture entitled Forgiveness, Law and Justice.
Photo: Johan Roux

No one could have anticipated the atmosphere in which Prof Martha Minow would visit the Bloemfontein Campus. And no one could have predicted how apt the timing of her message would be. As this formidable Dean of Harvard University’s Law School stepped behind the podium, a latent tension edged through the crowded audience.

“The issue of getting along after conflict is urgent.”

With these few words, Prof Minow exposed the essence of not only her lecture, but also the central concern of the entire university community.

As an expert on issues surrounding racial justice, Prof Minow has worked across the globe in post-conflict societies. How can we prevent atrocities from happening? she asked. Her answer was an honest, “I don’t know.” What she is certain of, on the other hand, is that the usual practice of either silence or retribution does not work. “I think that silence produces rage – understandably – and retribution produces the cycle of violence. Rather than ignoring what happens, rather than retribution, it would be good to reach for something more.” This is where reconciliation comes in.

Prof Minow put forward the idea that forgiveness should accompany reconciliation efforts. She defined forgiveness as a conscious, deliberate decision to forego rightful grounds of resentment towards those who have committed a wrong. “To forgive then, in this definition, is not an obligation. It’s a choice. And it’s held by the one who was harmed,” she explained.

Letting go of resentment cannot be forced – not even by the law. What the law can do, though, is either to encourage or discourage forgiveness. Prof Minow showed how the law can construct adversarial processes that render forgiveness less likely, when indeed its intention was the opposite. “Or, law can give people chances to meet together in spaces where they may apologise and they may forgive,” she continued. This point introduced some surprising revelations about our Truth and Reconciliation Commission (TRC).

Indeed, studies do report ambivalence, disappointment and mixed views about the TRC. Whatever our views are on its success, Prof Minow reported that people across the world wonder how South African did it. “It may not work entirely inside the country; outside the country it’s had a huge effect. It’s a touchstone for transitional justice.”

The TRC “seems to have coincided with, and maybe contributed to, the relatively peaceful political transition to democracy that is, frankly, an absolute miracle.” What came as a surprise to many is this: the fact that the TRC has affected transitional justice efforts in forty jurisdictions, including Rwanda, Sierra Leone, Cambodia and Liberia. It has even inspired the creation of a TRC in Greensborough, North Carolina, in the United States.

There are no blueprints for solving conflict, though. “But the possibility of something other than criminal trials, something other than war, something other than silence – that’s why the TRC, I think, has been such an exemplar to the world,” she commended.

Court decision cannot rebuild a society, though. Only individuals can forgive. Only individuals can start with purposeful, daily decisions to forgive and forge a common future. Forgiveness is rather like kindness, she suggested. It’s a resource without limits. It’s not scarce like water or money. It’s within our reach. But if it’s forced, it’s not forgiveness.

“It is good,” Prof Minow warned, “to be cautious about the use of law to deliberately shape or manipulate the feelings of any individual. But it is no less important to admit that law does affect human beings, not just in its results, but in its process.” And then we must take responsibility for how we use that law.

“A government can judge, but only people can forgive.” As Prof Minow’s words lingered, the air suddenly seemed a bit more buoyant.

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