Norcini et al. (2011) are to be congratulated for putting together an excellent summaiy of the state-of-the-art in medical education assessment. If there is anything missing in their summary, then it is in the field of cost. They mention costs but only twice and only briefly - as a feature of feasibility that is important to both examinees who are paying to sit and governments who are paying to set (cost unsurprisingly is important to those who foot the bill). We know an increasing amount about what constitutes a high-quality assessment - for example, to mention just two features, the need to use multiple methods in assessment and multiple occasions to assess. However, we know less about cost in assessment. According to government figures, the UK spends ￡4.8 billion annually on healthcare professional education but we do not know how much of that is spent on assessment.
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