Co-Designing a Justice-Oriented Assessment System in a Pediatric Residency Program: Report from the Designing for Equity in Medical Education Project.

Background and Need for Innovation: There is a large body of evidence that assessment systems in medical education are inequitable for many groups of learners. A common approach to improve equity has been the use of organizational strategies, where training program leaders work to develop and implement improvements in existing assessment systems from their perspective to improve equity. However, emerging assessment approaches, such as justice-oriented assessment, argue that assessment systems must be made more equitable by critique and re-building through co-design with learners, assessors, and other key users. Little is known about how to apply these methods to workplace-based assessment in medical education. Goal of Innovation: To fill the knowledge gap about how to co-design a more equitable, justice-oriented, workplace-based assessment system in pediatric post-graduate medical education. Steps taken for Development and Implementation of innovation: Using the Design Justice framework, the authors completed 4 of the 5 phases of Design Thinking to co-design with learners and other users a workplace-based assessment system in their institution's pediatric residency program. Evaluation of Innovation: To understand whether and how Design Justice principles were present and operationalized in the process of co-designing the assessment system, the authors evaluated the design activities in each phase of the Design Thinking process, the outputs of the design process, and the experiences of participating users. Critical Reflection: Evidence of Design Justice principles included participants' feelings of being heard, affirmed, and empowered, as well as the design teams' iterative, critical reflection on making the project accessible, accountable, sustainable, and collaborative. This project offers a practical example of co-designing a justice-oriented assessment system, the process and principles of which can inform the efforts of advancing equity in assessment.