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Longitudinal Assessments 101: Rethinking Continuous Competence

by | Assessments

As any credentialing board committed to the public’s protection will recognize, a test is but one step on the journey of lifelong learning.

Practitioners must be also able to prove on an ongoing basis that they are current with their knowledge. To do that, there is a need to establish recertification processes. Accreditation standards, like the National Commission on Certifying Agencies (NCCA) and the International Standards Organization (ISO) 17024, emphasize that need.

Enter longitudinal assessments, an emerging examination model within the credentialing community. Several prestigious medical boards have embraced them, and practitioners have responded with enthusiasm. As a means to assess current knowledge and promote learning, they mark an innovation in continuous competence. For organizations invested in safeguarding public trust, their implementation is worth consideration.

What are longitudinal assessments?

When it comes to credentialing organizations, the term “longitudinal assessment” has a meaning true to its name:

It is an assessment that an organization administers over an extended period.

Let’s say that an organization offers a high-stakes recertification exam every 10 years. It is pass/fail; if a practitioner passes, they maintain certification. If they don’t, they must re-test, or undertake some form of remediation.

What if, over that decade, they divided that one large test into smaller “chunks,” and administered each chunk as a discrete exercise? The results would still add up to a single score and a single result.

That is, in its most basic form, an example of a longitudinal assessment.


Beyond this simple definition, longitudinal assessments have the potential to transform an organization’s approach to continuous competence. Consider that, while overall scores can be calculated cumulatively, longitudinal assessments offer results at each interval, so practitioners receive more constant, ongoing feedback on their performance.

Not only does this promote knowledge retention, it allows practitioners to direct their learning towards areas of weakness. The most advanced longitudinal assessments can even use intelligence to deliver items that focus on content areas where the practitioner may have had difficulty in previous sessions.


Organizations that take continuing competence seriously can struggle to find the right form of assessment, as well as the right length for a recertification cycle.

Some have adopted traditional recertification exams, which are often administered every 10 years. These organizations face the unfortunate prospect that every 10 years, the stress and disruption of a high-stakes exam will discourage practitioners from recertifying.

Some organizations have designed more elaborate processes, like performance in practice (PIP) assessments. Due to the administrative burden of collecting and sharing patient data, these assessments have received considerable practitioner pushback.

And still others rely on a continuing education program to ensure continuous competence. These CE programs have faced the criticism that their design lacks rigor and relevance.

These struggles can cause credentialing boards to eschew these options entirely, often without replacing them. Longitudinal assessments present an alternative to these recertification models, one that removes burdens for practitioners without sacrificing rigor.


There are no codified standards or rules around administering longitudinal assessments. That said, specific common characteristics have emerged from successful implementations over time. These characteristics often involve an assessment’s rigor, accessibility, and impact, and can include:

  • On-demand delivery: administered at the practitioners’ convenience
  • Free of charge: delivered without fees, removing financial obstacles to participation
  • Mobile-device friendly: designed for phones and tablets, maximizing their accessibility
  • Open book: created with anticipation that test takers have access to external resources
  • Timed: structured to emphasize knowledge recall
  • Aggregated: assembled as a single, comprehensive representation of a person’s performance
  • Psychometrically sound: designed to ensure item quality and examination validity

More advanced characteristics include:

  • Adaptive item selection: incorporating algorithms to determine which items and domains to administer
  • Reflective practice: designed to encourage learning in areas identified by past test results


What are the benefits of longitudinal assessments for practitioners?

It isn’t hard to speculate about why practitioners might embrace longitudinal assessments. Consider the following:

  • No travel and interruption to busy work schedules. Imagine taking your recertification exam on your bus home from work!
  • Lower stress due to smaller assessment increments — no 10-year mega-exams to cram for (and fret over).
  • Instant feedback to let practitioners know where they stand. You’ll know right away if you know what you think you know.
  • Guidance on learning priorities. The assessment becomes a tool for shaping educational journeys according to knowledge gaps.


What are the benefits of longitudinal assessments for certification boards?

“Practitioner acceptance” may be the major driver for adopting longitudinal assessments. That doesn’t mean there isn’t remarkable alignment between practitioners and their certification boards! After all, practitioners need to practice, and boards need to protect the public.

Among the benefits credentialing boards cite for longitudinal assessments are:

Improved recertification rates

Deciding to stick with a program is easier when not facing the daunting prospect of a high-stakes exam

Precision and rigor

Longitudinal assessments use the same psychometric tools as high-stakes assessments to manage compliance. This sets them apart from continuing education programs.

Are there challenges related to longitudinal assessments?

Any new practice brings new challenges. Organizations that have implemented longitudinal assessment programs tend to cite the following:


Longitudinal assessments are still relatively new to the credentialing world, and thus, no one has quite figured out all the variables that affect longitudinal exam integrity. Some of the characteristics of lower-stakes assessments inevitably creep in, such as the impact of the delivery model on test-taking hygiene. And, because it takes so long to complete an assessment cycle, it can also be harder to collect data.

Nonetheless, high-stakes assessments and longitudinal assessments share the same requirements for design. Exam items still need to follow rigorous principles for difficulty, relevance, and lifespan. Standards must be set and scores assigned.

System complexity

Any new program design or major change to your evaluation process is bound to introduce unanticipated complexity to existing software platforms.

Once designed and implemented, longitudinal assessments will need to participate among other requirements, thereby adhering to complicated rules.

And what if your longitudinal assessments use a different platform altogether? Exchanging access, information, and results between them may necessitate complex technical integration protocols. Your system may require considerable customization.

A changing relationship with credential holders

Perhaps the most transformative aspect of transitioning to a longitudinal assessment is how it affects a board’s relationship with the credential holder.

In a longitudinal model, the board becomes a partner in the learning process, more than just an assessor of competence. Now, there is a possibility to directly impact practitioner proficiency.

For board that have established a firewall between assessment and learning, this evolving relationship may be cause for considerable soul-searching. At the same time, it’s hard to argue against helping maintaining proficiency. It’s even harder to argue against helping increase it. Once embraced, the outcome of taking this more active role is usually considered positive.

Longitudinal Assessments: The leading edge of evaluating continuous competence

Longitudinal assessments promise a revolutionary way to promote continuous competence. They encourage credential holders to take an active role in their lifelong learning. They reduce stress and disruption. They promote collaboration between practitioners and their credentialing authorities.

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