Asset Framing: a Tool for Enhanced Equity in Feedback and Assessment

Abstract

Asset framing can enhance equity in feedback and assessment in medical education. It is said that what you find depends on how you see, and the narratives that we build in our minds can influence our judgement and our assessments when working with learners. Asset framing has been used in other fields, and found to be an effective tool to reduce bias and enhance equity. In our article, we discuss biases that may occur in assessment and feedback, and how asset framing can be an effective tool to help mitigate this. We propose solutions at individual, departmental, and institutional levels.

Where is the Problem in Feedback and Assessment in Medical Education?

It is said that what you find depends on how you see [1]. We all look at things through our own lens of subjectivity. Narratives that we build in our minds are powerful tools that can overshadow facts and inadvertently introduce bias. We often start with a narrative in our minds, and interpret everything else to fit that narrative, [2] — a form of confirmation bias. It is therefore imperative that we pay close attention to these narratives.

As human beings, it is impossible to be totally free of bias. Our individual life experiences and identities mediate our understanding and interpretation of the world [3]. Unconscious bias has also made its way into education and comes in many forms [4]. Assessment bias disproportionately impacts those who do not resemble or share an identity with the assessors. Moreover, this bias has a cumulative effect, such as impact on Alpha Omega Alpha (AOA) Honor Medical Society selection, specialty choices, and career trajectory [5].

In education, there is sometimes an emphasis on “scarcity narratives” or “deficit framing” when working with learners. These narratives focus on learner deficits as the main drivers of feedback and assessment. Examples of deficit framing may include the following: labeling first-generation medical students as being “at risk,” interpreting quiet or introverted students’ performance as being unengaged, highlighting lower scores on standardized tests for students who are underrepresented in medicine (URiM), as just a few examples. While exploring opportunities for improvement is pivotal for learners’ growth, the approach to framing of these concerns is important. Deficit thinking tends to point the blame at individuals, whether directly or indirectly, and often ignores the underlying drivers of those deficits [6]. Additionally, deficit framing highlights shortcomings and reinforces negative stereotypes, and can sabotage equity and our ability to find effective solutions [7, 8]. “Messages of perpetual underachievement can inadvertently reinforce negative stereotypes and increase bias” [6, 9].

Recommendations have been made to counter bias in assessment, including requiring anti-bias training and establishing clear criteria for competency-based training [10], and yet, the mindset with which we start our assessments is a powerful tool — for good or bad. Defining learners by their challenges leads to unconscious stigma, which is psychologically difficult to mitigate, despite best intentions [11].

What is Asset Framing and Why is it Important?

The other side of the coin of deficit framing is asset framing, or strength-based framing. “Asset-framing works to define people by their aspirations, not their challenges.” [12] It “emphasizes discovering, affirming, and enhancing the capabilities, interests, knowledge, resources, goals, and objectives of individuals” and highlights learner empowerment, learning alliances, and mutual growth [13]. This is not a pollyannish or “positive-thinking” approach that ignores areas of weakness, but instead, this approach “focuses on the identification and use of an individual’s strengths and resources to problem solve and effect change” and thereby facilitates discovery and critical reflection, while highlighting learning partnerships between learner and teacher [14, 15]. Indeed, educators’ mindsets impact learners’ engagement and motivation [16].

Asset framing doesn’t ignore challenges. It’s not about avoidance or substitution. [2] It “is not about spin or hiding real gaps” [17]. Rather, asset framing steps away from a student-blame approach, and highlights the responsibility of leaders to support individuals in a learner-centered, solutions-oriented approach, and can be an important tool in enhancing the promotion of equity.

Understanding deficit framing and asset framing is particularly important in both formative and summative assessments in medical education.

How Can Asset Framing Help and What are Practical Steps?

Asset framing helps set the appropriate mindset for equity in teaching and assessment, developing a “self-awareness around the environment that we create for students” [18]. Starting by acknowledging students’ assets, aspirations, and strengths can be a more powerful tool to achieve improvement and growth, instead of starting with deficit-focused reproof [19].

What are Practical Steps to Move Towards Asset Framing in Medical Education?

Action at the Individual Educator and Educational Leader Level:

Many individual educators and educational leaders may not be aware of the strengths of the learners that they are assessing, particularly those who may come from different backgrounds or have a different approach to learning. This may be exacerbated by unconscious bias in assessment. Examples include an educator who is extroverted and may misinterpret the performance of more introverted, quiet learners, or fail to recognize strengths that they bring, such as good listening skills. Another example may be that educators who have not themselves experienced challenges or barriers in the learning environment may not recognize the strengths that a student who has overcome barriers may bring to the learning environment. It is therefore important that part of the solution focuses on individual educators and educational leaders.

Shift the Paradigm: Moving from Being “Fixers” to Being “Builders”

As educational leaders, it is helpful for us to revisit the framework and mindset that we use when approaching concerns about learners’ performance. Instead of viewing ourselves as “fixers” of deficit-ridden learners, we shift our focus to a system that is responsible for building learners and meeting them where they are — “builders,” taking back the responsibility of learners’ performance rather than placing the responsibility solely on the learners. As Reich notes “I used to think more about ways the student could change to better participate in the classroom, but now I think: ‘What can I do to be more effective and to meet this student where they are?’” [18].

Replace the Narrative in Assessment: Reframe Attitudes

The language we use as educators plays a powerful role in dictating attitudes, feeding into or negating biases, and framing our conversation around learners. Expectation bias, where one sees or hears what they expect to hear or see rather than what actually may be happening, is known to impact student performance [20, 21].

The educational literature often uses terminology that describes adult learners by their vulnerabilities, using labels that set the stage for bias, such as “at risk” and “low income,” thereby short-changing our ability to see the whole person and the strengths that they bring [22, 23]. By using an asset framing approach, we are rethinking how we discuss individuals and what they bring to the table, as opposed to how they do not measure up to the “standard” [17]. Understanding that the asset framing, or strength-based approach, can not only enhance equity, but also potentially improve learners’ confidence and cognitive and technical performance, is important for all educators and educational leaders [24]. These are practical steps towards achieving an asset-based pedagogy, which can help result in higher learner achievement [25].

Role Model Asset Framing in Other Contexts

Educators and educational leaders may also role model the use of asset framing in other contexts and situations — beyond feedback and assessment — such as in patient care. For instance, in discussing non-adherence with medication, an asset framing approach may focus on a patient’s resilience despite several systematic barriers to care. In other words, asset framing becomes part of our culture in framing our thoughts and our discussions in all settings.

While deficit framing places the onus on the learner, asset framing highlights the responsibilities of the system towards the learner, and focuses on a way forward (please see Table 1).

Table 1.

Examples of asset framing vs deficit framing

+ Asset framing that focuses on a way forward	- Deficit framing (scenarios commonly misperceived as deficits)
First-generation medical students have demonstrated significant resilience and adaptability, and some may need additional support	First-generation medical students may experience difficulty in acclimating to the strenuous demands of medical school, so it is not unexpected for some to perform at a lower level
Students who are under-represented in medicine (URiM) have frequently overcome systematic and cumulative barriers	Students who are under-represented in medicine (URiM) tend to score lower on standardized exams
Quiet, introverted students often demonstrate good listening skills which allow them to establish rapport with patients	Quiet students appear disinterested and unengaged
Student with diverse background brings a different perspective that helps build rapport with patients	Student with disability
Student has unique insight on needs of patients and potential barriers at home. Student is relatable	Student who is a mother with young children
Student has excellent skills and high interest in recognizing social determinants of health and providing equitable care. We should use this strength as a springboard to work with them on clinical reasoning	Student/resident appears to be lacking in clinical reasoning
Student thrives in high paced environment and values efficiency	Student often seems to be in a hurry to get things done

Action at the Departmental and Institutional Levels:

Train Educators and Leaders in Medical Education on Asset Framing

As educational leaders, we set the tone for how we talk about and assess our learners. Therefore, educating leaders on the use of asset framing as an approach to help mitigate bias in assessing learners is important.

Educational leaders should role model the use of asset framing, and feel empowered to redirect and reframe conversations using this approach.

Place the Learner’s Assets and Aspirations at the Heart of Their Assessment

Program-wide assessment committees should introduce learners by their assets, aspirations, and contributions before describing challenges or deficits [11], with the intent of coaching learners on their journey to achieve their goals. It is important to partner with learners to craft goals that are not only asset-focused, but also fulfill patient care and societal needs. For instance, educational committee discussions can start with a “one liner” for each learner that highlights their individual strengths and goals. Individualized learning plans based on this asset-focused framework increase learner motivation and sense of belonging [26].

Diverse Faculty Representation

Implicit bias can impact how asset framing occurs. Racial discordance between faculty member and learner can negatively impact expectations and performance [20]. Diverse faculty representation is therefore another important factor that we must be mindful of. Diversity is important in highlighting cultural norms and their potential impact on educational nuances, feedback approaches, as well as successful approaches to effective asset framing in a diverse student body.

Addressing “Assessment from a Distance” Concerns: Intentional Structured Support for Improvement

Educational leaders are not necessarily those with the most intimate knowledge of individual learners’ assets, goals, and aspirations, and yet it is typically educational leaders who are responsible for the final assessment of learners. This “assessment from a distance” system, where summative assessment is occurring from afar, and by educational leaders who do not necessarily know the learners’ performance well enough to comment on their assets (and deficits), may be poorly informed, inaccurate, and less useful. Therefore, engaging faculty members who know individual learners well, and are familiar with their performance, ideally by direct observation, allows for a more robust — and fair — assessment system. These faculty members may include mentors who work closely with learners. Mentors can help close this gap with a learner-centered asset framing approach, supporting mentees in advancing their skills as needed, thereby centering the learner as “the protagonist in the story” and positioning programs “as a resource or partner to your protagonist’s aspirations” [11].

Conclusion

In summary, as opposed to the traditional deficit-based approach in education, a strength- or asset-based approach to medical education, especially in the arenas of feedback and assessment, is an important tool for developing learner-educator alliances. This framework facilitates discovery and critical reflection, while highlighting learning partnerships between learner and teacher. It is important to highlight that asset framing is not a pollyannish or naïve approach to assessing learners, and that this approach does not merely focus on assets or strengths while ignoring opportunities for growth. Instead, it is a learner-centered approach that starts by understanding, appreciating, and acknowledging areas of strengths, and tailors opportunities for growth based on individual students’ needs, goals, and aspirations. Concurrently, the asset framing approach highlights the responsibility of educational leaders in partnering with learners to develop an asset-informed, goal-oriented, and individualized approach to continued growth and development.

It is time for us, as educators and educational leaders, to revisit our approach to feedback and assessment, and to ensure that these processes are individualized, learner-centered, and solutions-oriented.

Declarations

Conflict of Interest

The authors declare no competing interests.