Abstract: Programmatic assessment has undergone stages of emergence, evolution, entrenchment, and practical application, ultimately forming a framework of low-stakes assessment- intermediate review-high-stakes decision-making. From the perspective of educational design, programmatic assessment integrates various assessment methods into the educational process based on competency objectives, closely aligning assessment with teaching to achieve assessment for learning and assessment as learning. Programmatic assessment emphasizes concepts including systematic information integration, continuous longitudinal assessment, and the continuum of stakes, while adopting approaches like test-enhanced learning, overlearning, distributed learning, interleaved learning to accelerate personalized learning for learners. It is essential for medical educators in China to recognize, understand, and apply programmatic assessment in clinical education, adjust the existing information systems and regular teaching practices, promote the application of artificial intelligence, and avoid potential risks, thereby effectively implementing competency-based medical education.    

Key words: Programmatic assessment, Assessment for learning, Assessment as learning, Education design, Clinical teaching