When learning objectives, learning approaches, and assessment are well-aligned, it creates a cohesive and effective learning experience for medical students. Students understand what is expected of them, and the teaching methods and assessment support their attainment of these expectations. This alignment not only promotes successful learning outcomes but also ensures that graduates are well-prepared to enter the medical profession as competent and safe healthcare practitioners.

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Professional competence represents the basis for performing tasks of high complexity (ten Cate et al, 2010).It is defined as the integral use of knowledge, skills, clinical reasoning, values and reflection in daily practice for the benefit of the individual and the health care needs of the community (Epstein et al., 2002). 

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There are two contrasting approaches to assessing competence. The analytic approach, which strives to precisely measure observable elements and facets of competence and the holistic approach, which focuses on a comprehensive evaluation of competences in complex real-life scenarios that reflect actual performance. Each approach plays a distinct role in assessing different aspects of competence, and they differ in terms of their underlying conditions and the types of measurements employed (Rotthoff et al., 2021).

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The analytic approach seeks objective and reliable measurements of competence constituents ((individual elements of knowledge, skills and attitude), utilizing a range of specific, mostly quantitative methods. Examples of such methods include multiple-choice question (MCQ) tests, standardized structured oral assessments, all of which employ clearly defined and uniquely measurable criteria. In contrast, assessments of competence facets (components of a patient encounter), which can be evaluated through simulations ranging from simple to complex tasks resembling real-world settings, require less standardization and objectivity. However, they offer higher authenticity and validity. To minimize rater subjectivity assessment anchors can be employed. Assessing competence of a physician from a holistic perspective involves evaluating their performance in the workplace. In such assessments, assessors subjectively determine whether they would entrust a task to a candidate and at what level of supervision. To mitigate the lack of standardization and objectivity in such assessment situations, assessment anchors can be used as well and a larger number of expert raters can be utilized (Rotthoff et al., 2021).

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Matching assessments should evaluate various aspects of competence throughout an academic programme. These assessments occupy a continuum between the analytic and holistic approaches, ultimately culminating in the observation of performance. Competence-based assessment does not favor either standardization or authenticity, nor does it favor control over trust. Instead, both approaches should be seen as interconnected rather than opposing poles (Rotthoff et al., 2021).