An educational evaluation of learner experiences in dentistry open-book examinations

Introducing Group Open-Book Exams as a Learning and Assessment Strategy in the Clinical Biochemistry Course for Medical Students

BACKGROUND

Teachers constantly strive to obtain reliable and appropriate teaching and assessment methods to maximize the learning experience. This study aimed to introduce combined modified team-based learning and open-book exams (TBL/OBEs) as learning and assessment strategies in clinical biochemistry for medical students and assess students' perceptions.

METHODS

Second-year medical students enrolled in the clinical biochemistry course were included in this study and subjected to TBL/OBE assessment. The assessment included two parts: the open-book format for half of the questions and the closed-book format for the other as a control. Upon completing the combined TBL/OBE session, the students were required to complete a structured survey to evaluate their perception of the experience. The data were gathered and analyzed. Data were presented as mean±standard error of the mean (SEM), and a p-value ≤0.05 was considered statistically significant.

RESULTS

A total of 358 students completed the TBL/OBE and closed-book exam (CBE) and responded to the survey. Of these students, 76% preferred the OBE, and 84% thought it was a suitable learning method. On the one hand, the mean difficulty of the OBE format was 92.7±1.5 SEM, while, for the CBE, the mean difficulty was 88.7±1.9 SEM (p=0.015). On the other hand, the mean discrimination factor for OBE was 0.26±0.04 and, for the CBE, 0.41±0.04 SEM (p=0.0016). Males found the OBE questions easier (p=0.025) and less stressful (p=0.01).

CONCLUSION

A combined model of modified TBL and OBE is a successful learning and assessment strategy in clinical biochemistry for medical students.

Health worker education during the COVID-19 pandemic: global disruption, responses and lessons for the future-a systematic review and meta-analysis

BACKGROUND

This systematic review and meta-analysis identified early evidence quantifying the disruption to the education of health workers by the COVID-19 pandemic, ensuing policy responses and their outcomes.

METHODS

Following a pre-registered protocol and PRISMA/AMSTAR-2 guidelines, we systematically screened MEDLINE, EMBASE, Web of Science, CENTRAL, clinicaltrials.gov and Google Scholar from January 2020 to July 2022. We pooled proportion estimates via random-effects meta-analyses and explored subgroup differences by gender, occupational group, training stage, WHO regions/continents, and study end-year. We assessed risk of bias (Newcastle-Ottawa scale for observational studies, RοB2 for randomized controlled trials [RCT]) and rated evidence certainty using GRADE.

RESULTS

Of the 171 489 publications screened, 2 249 were eligible, incorporating 2 212 observational studies and 37 RCTs, representing feedback from 1 109 818 learners and 22 204 faculty. The sample mostly consisted of undergraduates, medical doctors, and studies from institutions in Asia. Perceived training disruption was estimated at 71.1% (95% confidence interval 67.9-74.2) and learner redeployment at 29.2% (25.3-33.2). About one in three learners screened positive for anxiety (32.3%, 28.5-36.2), depression (32.0%, 27.9-36.2), burnout (38.8%, 33.4-44.3) or insomnia (30.9%, 20.8-41.9). Policy responses included shifting to online learning, innovations in assessment, COVID-19-specific courses, volunteerism, and measures for learner safety. For outcomes of policy responses, most of the literature related to perceptions and preferences. More than two-thirds of learners (75.9%, 74.2-77.7) were satisfied with online learning (postgraduates more than undergraduates), while faculty satisfaction rate was slightly lower (71.8%, 66.7-76.7). Learners preferred an in-person component: blended learning 56.0% (51.2-60.7), face-to-face 48.8% (45.4-52.1), and online-only 32.0% (29.3-34.8). They supported continuation of the virtual format as part of a blended system (68.1%, 64.6-71.5). Subgroup differences provided valuable insights despite not resolving the considerable heterogeneity. All outcomes were assessed as very-low-certainty evidence.

CONCLUSION

The COVID-19 pandemic has severely disrupted health worker education, inflicting a substantial mental health burden on learners. Its impacts on career choices, volunteerism, pedagogical approaches and mental health of learners have implications for educational design, measures to protect and support learners, faculty and health workers, and workforce planning. Online learning may achieve learner satisfaction as part of a short-term solution or integrated into a blended model in the post-pandemic future.

Effects of a blended design of closed-book and open-book examinations on dental students' anxiety and performance

BACKGROUND

While closed-book examinations (CBEs) have traditionally been implemented in dental education, open-book examinations (OBEs) are being introduced for the purpose of acquiring higher levels of knowledge and promoting long-term memory. This study examines whether it is effective to use a blended assessment of CBEs and OBEs for dental students to reduce test anxiety and enhance academic performance.

METHODS

Using a quasi-experimental research method, a blended assessment that combined CBEs in class and OBEs online was designed for a dental course. In 2020, when the pandemic was at its peak, student assessment was ineffective, and the 2020 cohort was omitted for our study; instead, two cohorts of predoctoral dental students (N = 178) enrolled in Restorative Dentistry in the spring semesters of 2019 and 2021 were included in the study. These students were informed about the experimental design, and they provided written consent for data collection, thereby voluntarily participating in the survey. Their self-perceived responses to open-ended survey questions on assessment methods were qualitatively analyzed.

RESULTS

There was no significant difference in test anxiety between the CBEs and OBEs at the p-values of 0.001 in all items. Traditional and blended assessment showed a similar trend of lower scores in midterm exams compared to higher scores in final exams, thus discriminating against students' performances. In particular, a low-achieving group was better predicted by a blended assessment. An analysis of the students' self-perceived responses produced highly topical themes, including exam burden, learning effects, and fairness issues.

CONCLUSIONS

This study confirmed the feasibility of blended assessment that can be implemented in online and in-person educational environments. Moreover, it can be used as the groundwork to develop new models of assessment in dental education.