Summative assessment of medical students in the affective domain

A growing awareness of the importance of professional attitudes in medicine has lead to increased attention in medical schools to medical students' co mmunication skills and attitudes. Assessment of attitudes has always been l ess important than assessment of knowledge, cognitive skills and psychomoto r skills. This may partly be due to the conviction of medical educators ("w ho are we to assess attitudes of students with summative consequences?") an d partly to the lack of reliable and valid assessment instruments. A discus sion of the introduction of such assessment, against the background of grow ing interest in the Netherlands for procedures to seriously value attitudes in patient care, is presented. The University, of Amsterdam approach illus trates the possibilities of assessment of attitude and communication. Stude nts who,repeatedly do not meet the objectives in the affective domain may h ave to leave medical school.