Grading, Assessment, and Motivation to Learn

When I became a prosthetics instructor after more than 20 years in clinical practice, I quickly encountered what I came to recognize as one of the most persistent challenges in teaching O&P: Student performance was graded on skills for which few valid or reliable measures existed in clinical practice. Grades are the most common method for describing learning achievement at almost all levels of education, but I found that grading often fell short of meaningfully assessing and communicating student performance. A high-performing student in one of the first cohorts I taught received an 88 percent (B) on a prosthesis fitting. She asked what she could have done differently to receive 2 percent more, a difference that would have resulted in a full grade letter increase. This student had a genuine interest in learning as well as improving her grade, but I noticed that for many students grading put the focus on points instead of learning.

Our profession lacks objective criteria for determining the quality of impressions, modifications, and the resulting socket. This was confirmed in a 2022 scoping review that found that “most measures of socket fit rely on a patient’s self-report and may vary with biopsychosocial factors unrelated to the socket fitting process” and that “alignment is determined mostly by the prosthetist’s judgment.”¹ The authors concluded that “efforts to standardize and validate measures of these parameters of prosthetic fitting are vital to improving clinical practice and reporting outcomes.”¹ This call for standardization and validation is equally applicable to the measurement of learning outcomes. If device fit and function is an inadequate way to assess learning, and grades do not accurately describe it, what are the alternatives?