Use of the Muddiest Point Technique as an exam review in an integrated pharmacotherapy course

Implementation and initial evaluation of an exam self-reflection process

OBJECTIVE

To implement a standardized approach to exam review for Doctor of Pharmacy (PharmD) students and assess its effect on students' perceptions.

METHODS

Over the academic years 2022-2024, second-professional year pharmacy (PharmD) students scoring less than 73 % on major midterm examinations were required to complete an exam self-reflection form in two pharmacotherapeutics courses. A survey was developed and distributed to all students enrolled in the pharmacotherapeutics courses to assess students' opinions about the exam self-reflection process.

RESULTS

One hundred and twenty-two responses were received for the survey over the three semesters (95 % response rate). The majority of students expressed satisfaction with the benefit (92 %) and importance (87 %) of implementing the self-reflection process using the exam self-reflection form within the pharmacotherapeutics courses. Amongst students who submitted the exam self-reflection form (n = 58), survey data revealed that 76 % were overall satisfied with the self-reflection process using the exam self-reflection form. Students' satisfaction was also expressed in terms of supporting its continuation (66 %), recommendation in other courses (64 %), time spent completing the form (67 %), assistance with preparing for the remediation exam (85 %), impact on remediation score (79 %), confidence with course content (91 %), understanding of course content (97 %), test-taking skills (76 %), knowledge gap identification (88 %), and value (66 %).

CONCLUSION

Students positively perceived the exam self-reflection process. Future directions include evaluating exam data to determine the quantitative impact of the exam self-reflection review approach.

A mixed-methods approach to repetitive formative assessment with timely feedback on instructional perception in doctor of pharmacy students

INTRODUCTION

Formative assessment assists learning, but how Doctor of Pharmacy (PharmD) students perceive repeated formative assessment is unclear.

METHODS AND MATERIALS

This study sought to determine perceptions of repeated formative assessment with timely feedback on student learning in third-year PharmD students. This mixed methods approach included four surveys and a qualitative interview. Five formative assessments were assigned to third-year PharmD students throughout a fall course, and then repeated in a spring course for the same cohort. Paired pre-and post-course surveys administered in both courses contained items corresponding to formative assessment perceptions. Survey items included domains of knowledge, engagement, feedback, and confidence, and effect size was determined using Cohen's d. Following the second course, students were invited to take part in a qualitative interview to further characterize perceptions.

RESULTS

Overall, 19 and 18 students participated in paired fall and spring pre- and post-surveys, respectively. The standardized mean difference for 12 out of 24 total survey items (58.3%) indicated small to medium positive effect sizes following the intervention, two out of 24 (8.3%) with medium to strong positive effect sizes, and one out of 24 (4.17%) with a strong positive effect size. Eight students participated in a quantitative interview; response themes included "think," "critiquing," "helped," and "helpful."

CONCLUSIONS

In two PharmD courses, students expressed a generally small to moderate perceived benefit on repeat formative assessment in domains representing knowledge, engagement, feedback, and confidence.

Revitalizing the Muddiest Point for Formative Assessment and Student Engagement in a Large Class

BACKGROUND

Ascertaining student understanding can be challenging in large-enrollment and hybrid or asynchronous courses.

PROBLEM

Instructors needed an innovative instructional strategy to encourage student engagement and support learning in a large-enrollment, mixed-format pathophysiology class.

APPROACH

A weekly, graded assignment was created by merging the formative assessment commonly referred to as the muddiest point (MP) with an asynchronous discussion board activity within the learning management system. Each week, students were required to submit a question and respond to a peer. Instructors created a remediation lecture based on the most common student questions.

OUTCOMES

The majority of students reported they benefitted from the MP discussion boards and remediation lectures.

CONCLUSIONS

The MP discussion board activity is a flexible, instructional strategy to determine areas of confusion, increase student engagement, and facilitate learning in large-enrollment classes offered in multiple formats.

Use of End-of-Class Quizzes to Promote Pharmacy Student Self-Reflection, Motivate Students to Improve Study Habits, and to Improve Performance on Summative Examinations

Underperforming students are often unaware of deficiencies requiring improvement until after poor performance on summative exams. The goal of the current study was to determine whether inclusion of individual end-of-class formative quizzes, which comprise of higher level Bloom's questions, could encourage students to reflect on and address deficiencies and improve academic performance. Ninety-seven out of 123 first-year pharmacy students (79%) enrolled in a Biochemistry and Cell & Molecular Biology course participated in a single-blinded, randomized, controlled, crossover study. Paired t-test analyses demonstrated that that implementation of individual end-of-class formative quizzes resulted in significantly higher summative exam scores for below average students (p = 0.029). Notably, inclusion of quizzes significantly improved performance on higher Bloom's questions for these students (p = 0.006). Analysis of surveys completed by students prior to summative exam indicate that the formative end-of-class quizzes helped students identify deficiencies (89%) and making them feel compelled to study more (83%) and attend review sessions (61%). Many students indicated that quizzes increased stress levels (45%). Our collective data indicate that quizzes can improve summative exam performance for below average first year pharmacy students, and improve self-reflection and student motivation to study. However, the impact on student stress levels should be considered.