Naming my assumptions out loud led me somewhere uncomfortable. If assessment is fundamentally about students and their learning, I have to ask which students my assessments serve well and which they may quietly disadvantage. My cohorts are not uniform; some students are multilingual or come from different cultural and educational backgrounds. Burns, Lundgren, and Vecchie (2020) argue that although students learn in many ways, their learning is often assessed in narrow, standardized forms, and that culturally responsive assessment asks instructors to include students in the process, reconceptualize what counts as evidence, examine equity directly, and increase transparency and accessibility. Read against my own practice, that is pointed. My reliance on timed written examinations and on the recall of medical directives confounds clinical competence with English-language proficiency and test-taking fluency, so a capable clinician who is a second-language speaker can underperform for reasons unrelated to whether they can manage a patient. Burns and colleagues (2020) name exactly this interaction between assessment modality and student background, which reframes my scenario-based and self and peer assessments as not merely sound but more equitable, because they let competence show itself in more than one register.
A more honest reckoning also requires admitting what I do not know. Montenegro and Jankowski (2017) argue that culturally responsive assessment means disaggregating results to see whether equity gaps are present, and I cannot say whether my OSCE or global-rating-scale pass rates differ across student backgrounds, because I have never looked. Recognizing that absence is itself a first step; I cannot claim a culture of assessment about students and their learning while remaining incurious about whether my gates fall unevenly. Building that inquiry into how I review assessment data is a concrete commitment I take from this course.
The harder truth concerns the standard itself. Certification is, by design, a standardizing gate: it asks whether the student meets the standard, not whether the standard might encode a particular way of knowing the body, the patient, and the proper conduct of a call. Heringer and Janzen (2023) warn that closing an achievement gap can be framed as a moral good while leaving the curriculum, standards, and measures themselves unquestioned, so that what looks like inclusion can in fact be assimilation to a single, dominant norm. Drawing on Tuck and Yang, they remind us that decolonization is not a metaphor for general improvement; it asks whose knowledge and whose presence the institution was built to serve (Tuck & Yang, 2012, as cited in Heringer & Janzen, 2023). I want to hold two things at once here, and the tension between them is the point. The fixed floor of critical safety skills must not move: an airway is an airway, and I will not romanticize patient harm in the name of inclusion. Yet the surrounding judgments, how a competent assessment is narrated, what professional presence is supposed to look like, how rapport with a patient is recognized and scored, are not culturally neutral, and the global rating scale leaves room for an assessor’s unexamined expectations to operate as if they were. I cannot decolonize cardiopulmonary resuscitation, and I would not pretend to. What I can do is hold the safety floor firm while becoming critically conscious of how identity and culture move through everything built on top of it, and refuse to mistake conformity to my own expectations for competence.