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Portanova et al • Medical education It is increasingly apparent that medical education has not kept pace with the evolving healthcare system. In a previous communication, the authors addressed this problem by proposing an “osteopathic prescription for medical education reform.”1 In keeping with the tenets of that proposal, during the past several years, curriculum reform has been a priority at the Ohio University College of Osteopathic Medicine (OUCOM). Our goal has been to develop a continuum of physician training, that is, a seamless, osteopathic medical curriculum, integrated both vertically (across time) and horizontally (across disciplines), and encompassing the period from matriculation to the completion of a primary care residency.2,3 Specific milestones in this endeavor include the following: 1994—Introduction of the patientcentered continuum (PCC), a studentdirected, case-based curricular track, founded on continuum education principles, and available to 20% of the undergraduate class2; 1995—Establishment of the Centers for Osteopathic Research and Education, or CORE system; this statewide undergraduate and graduate medical education consortium—Osteopathic Postdoctoral Training Institution (OPTI)— provides the administrative and logistical system necessary to deliver a “true” medical education continuum4; and 1999—Introduction of the clinical presentation continuum (CPC); this curricular track, inspired by the University of Calgary in Canada,5 is organized around common patient presentations, largely faculty-directed, incorporates continuum education principles, and is available to 80% of the undergraduate class. (The CPC will be the subject of a forthcoming article.) One important aspect of medical education reform—some would argue the aspect most important and most difficult to change—is student assessment. In a recent report concerning changes in student assessment implemented by eight schools participating in The Robert Wood Foundation’s “Preparing Physicians for the Future: Program in Medical Education,” Mennin and Kalishman6 refer to the 30-year history of consistent calls for revision of student evaluation techniques. They conclude that assessment, by its very nature, evokes issues of governance, control, and power and hence is resistant to change. At the same time, they stress the singular importance of assessment in determining the ultimate success or failure of attempts at curriculum reform. A quote by a faculty member at one of the eight participating schools poignantly makes this point: “...[student] assessment does drive the curriculum, and traditional assessment drives the curriculum into tradition. Every place we did not change [assessment], the curriculum is being driven back to whatever it was before....” At OUCOM, we are inclined to believe that this unidentified faculty member is correct and consequently have included comprehensive, integrated assessment of cognitive and noncognitive performance as explicit components of curricular reform: progress testing and the objective structured clinical examination (OSCE). A status report on our experiences to date, together with a brief review of the pertinent literature, follows.

Student assessment in the Ohio University College of Osteopathic Medicine CORE system: progress testing and objective structured clinical examinations