The Effect of Assessments on Student Motivation for Learning and Its Outcomes in Health Professions Education: A Review and Realist Synthesis

Describing the current landscape of pass/fail grading schemes within skills-based pharmacy curricula

INTRODUCTION

Optimal methods for grading students in skills-based courses within pharmacy education have not been fully explored. This research aimed to assess the current landscape of pass/fail grading schemes within pharmacy skills-based courses and explore faculty perceptions of pass/fail grading schemes.

METHODS

A 29-item, cross-sectional survey was electronically distributed to the American Association of Colleges of Pharmacy Laboratory Special Interest Group. The survey collected demographics, course grading schemes, faculty perceptions of student performance, and impact of implementing pass/fail grading schemes. Survey respondents were also invited to participate in semi-structured interviews, which were summarized due to limited participation. Descriptive statistics were used for analysis of survey data.

RESULTS

Fifty-five participants responded to the survey, representing 23 pharmacy institutions. Most respondents (82 %) used a traditional grading system for final course grades in skills-based courses. Some respondents (40 %) used specification grading for skills assessment, and 64 % of respondents used pass/fail grading to assess specific skills. Most respondents perceived that the change to pass/fail grading either improved or made no difference in faculty workload, wellbeing, general faculty creativity, quality of feedback, timeliness of grading, grade grievances, and faculty preparation time. The main concern was decreased student motivation and engagement. Semi-structured interviews identified a need for specific, validated rubrics, importance of faculty buy-in, and lack of impact on faculty workload as a result of the change. Concerns about residency placement and student motivation were also identified.

CONCLUSION

There is variability in grading schemes used within skills-based pharmacy curricula. Faculty perceptions of pass/fail grading schemes are positive overall. Considering the limited number of institutions utilizing this grading scheme, additional research is needed.

Debriefing to nurture clinical reasoning in nursing students: A design-based research study

BACKGROUND

Students' clinical reasoning can be stimulated by guiding them to use their experiences with patients to develop own illness scripts. Debriefing during hospital shifts invites students to put patient experiences into words, link them to previously acquired knowledge and make connections.

OBJECTIVES

To develop, implement and evaluate a debriefing procedure for nursing internships based on illness script theory and generate corresponding design principles.

DESIGN

Qualitative design-based research.

SETTING

Clinical education in dedicated educational hospital units.

PARTICIPANTS

Nurse educators, nursing students.

METHODS

From a collaboration between nurse educators and a researcher, a short, peer-debriefing procedure was designed, tested and enacted through four cycles of planning, action, evaluation and reflection. Students drew mind maps about patients. Nurse educators and students joined focus group discussions to evaluate outcomes and processes. Mind map and iterative thematic analysis were applied to these data.

RESULTS

An adjusted design and more extensive design principles resulted. Differences in mind maps were evident over time. Three themes in the process evaluation were established: trigger to reason; energy giving and taking; and form follows function.

CONCLUSIONS

This design-based investigation displays how nurse educators could design and implement a debriefing procedure to facilitate students' clinical reasoning skills and how students could learn from this. This method integrates research, innovation and collaboration. The design and enactment under real-life hospital conditions generated design principles for educators and researchers which may be useful for those seeking to improve teaching and learning clinical reasoning in practice. More clarification is needed about the path from design through enactment to real change in practice.

Promoting students' autonomous motivation for the ongoing curriculum using a 'Societal Impact Project' with basic psychological needs characteristics

PURPOSE

Autonomous motivation is important for university students, but it remains a challenge to stimulate their autonomous motivation for their curricula. We developed an extracurricular intervention (Societal Impact Project) with basic psychological needs supportive characteristics such as learning with self-defined problems relevant to curriculum and society, collaborative group work, and coaching by a teacher. This study aims at evaluating the intervention in fostering students' autonomous motivation for their regular curricula.

METHODS

We conducted a quasi-experimental study, using between-group pre- and post-test design. Participants from the intervention and control group completed a survey before and after the intervention, which measured the satisfaction of three basic psychological needs, autonomous motivation, controlled motivation, enjoyment, value, and well-being within their regular curricula. We compared the post-test differences between the two groups while controlling for pre-test scores.

RESULTS

Students in the intervention group had greater enjoyment in their regular curricula and perceived their regular curricula to have more value compared to students in the control group. The other variables did not differ significantly between the two groups in the post-test.

CONCLUSION

The intervention is effective for improving students' enjoyment and perceived value in their regular curricula. The variables with non-significant differences indicate the difficulty to alter students' basic psychological needs and motivation in their regular curricula, even after participating in a long-term intervention.

Assessment in community settings: Is there any role for individual competency-based assessment?

BACKGROUND

Oral forms of assessment remain a common part of competency-based assessment systems, yet their feasibility is being challenged. The focus on individual competence is problematic given the need to prepare health professionals for teamwork. The present study aimed to investigate how the assessment of collective competence compares to individual assessment, and to explore whether there is a need for individual assessment at all in community or population-based practice.

METHODS

A behavioural-based interview assessment was developed and trialled and correlated to performance as a team on placement. Correlation between student performance on individual behavioural-based interview and teamwork artefacts was assessed using Spearman rho. Differences between performance on individual oral assessment and team performance on artefacts at the cohort level was determined using the Mann-Whitney U-test. Bland-Altman analysis was completed to analyse agreement between performance on the individual oral assessment and team performance at the student level.

RESULTS

Students were final year nutrition and dietetics students from 2020, 2021 and 2022 years (total sample = 216) from one Australian university. There was a difference in performance between assessment types in each year and as a total cohort (p < 0.001) with students performing better in teamwork. There was no correlation between individual oral interview and team performance across all years. The results of the Bland-Altman analysis showed little agreement between the two assessment tasks.

CONCLUSIONS

Assessment of teamwork performance as part of a program of assessment is essential. More valid and reliable tools are needed to assess collective competence.

Development of a hybrid point-of-care ultrasound curriculum for first year medical students in a rural medical education program: a pilot study

BACKGROUND

The field of point-of-care ultrasound (POCUS) has advanced in recent decades due to the benefits it holds for medical providers. However, aspiring POCUS practitioners require adequate training. Unfortunately, there remains a paucity of resources to deliver this training, particularly in rural and underserved areas. Despite these barriers, calls for POCUS training in undergraduate medical education are growing, and many medical schools now deliver some form of POCUS education. Our program lacked POCUS training; therefore, we developed and implemented a POCUS curriculum for our first-year medical students.

METHODS

We developed a POCUS curriculum for first year medical students in a rural medically underserved region of the United States. To evaluate our course, we measured learning outcomes, self-reported confidence in a variety of POCUS domains, and gathered feedback on the course with a multi-modal approach: an original written pre- and post-test, survey tool, and semi-structured interview protocol, respectively.

RESULTS

Student (n=24) knowledge of POCUS significantly increased (pre-test average score = 55%, post-test average score = 79%, P<0.0001), and the course was well received based on student survey and interview feedback. In addition, students reported increased confidence toward a variety of knowledge and proficiency domains in POCUS use and their future clinical education and practice.

CONCLUSIONS

Despite a lack of consensus in POCUS education, existing literature describes many curricular designs across institutions. We leveraged a combination of student initiatives, online resources, remote collaborations, local volunteers, and faculty development to bring POCUS to our institution in a rural and medically underserved region. Moreover, we demonstrate positive learning and experiential outcomes that may translate to improved outcomes in students' clinical education and practice. Further research is needed to evaluate the psychomotor skills, broader learning outcomes, and clinical performance of students who take part in our POCUS course.