INTRODUCTION: Formative assessment with emphasis on feedback has been linked to developmental purposes of assessment, whilst summative assessment is assumed to focus on judgemental and quality assurance purposes. This dichotomy is questioned but designs to blend formative and summative assessments in constructive ways are rare in health care education.

METHODS: We have designed an assessment model blending formative and summative assessments . In the formative assessment at the end of a course, students' responses to real-life scenarios with questions demanding responses at the relational level of understanding were assessed at three levels of understanding (incorrect, descriptive, and relational) modified after the SOLO taxonomy. Students were presented with individual feedback for each response. At the summative assessment of a subsequent course, the students' new responses were assessed underpinning a final judgement of students' performance. The assessment model was justified across three student cohorts.

RESULTS: Both formative and summative assessment events of the model provided information about the levels of understanding, unique to each student. A comparison of results from the assessments demonstrated that most responses developed to a higher level of understanding. With the summative assessment it was possible to make judgements about whether or not individual students passed the pre-set standards.

CONCLUSIONS: We argue that the current assessment model presents real interdependence between formative and summative assessments and can provide information that meets the needs of students as learners, education institutes, and health care organisations. The SOLO taxonomy can be used to emphasise the importance of developing and assessing cognitive complexity.