Test-Only Learning via Virtual Patients to Improve Surgical Illness Scripts of Preclinical Medical Students as a Preparation for Clinical Clerkships: An Experimental Study

OBJECTIVE

The aim was to determine whether preclinical medical students can develop their illness scripts to a level comparable to that of clerkship students through test-only learning using repeated formative online testlets.

METHODS

In this experimental study, participants were 52 preclinical and 53 clinical medical students. The intervention group consisted of preclinical medical students, and the control group consisted of clinical medical students. The intervention group responded to online testlets containing feedback, an innovative formative assessment method called ContExtended Questions, on general surgery for 8 days by spending no more than 30 minutes each day. The control group completed the general surgery clerkship. The performances were assessed using 20 Key-Feature Question items. The intervention group was assessed twice: immediately after the intervention (the immediate test), and again 1 month later (the delayed test). The control group was assessed once, immediately after the clerkship. All performance tests were identical.

RESULTS

The preclinical students had a significantly higher mean score on the immediate test (83.1 ± 9.6) compared to the clinical students (75.4 ± 8.9), P < .001. The effect size (Cohen's d) was .83. However, the mean score in the delayed test (76.9 ± 13.6) was not significantly different from clinical students' mean score (75.4 ± 8.9), P > .05.

CONCLUSIONS

Test-only learning as a spaced repetition of online formative testlets is effective in preparing preclinical medical students to the clinical clerkship. Through using this approach in preclinical period, they can prepare themselves for the clinical environment to optimize the benefits derived from clerkships.

Evaluation of student readiness for clinical dental education at the end of preclinical education

OBJECTIVES

This study examined results of a summative objective structured clinical examination (OSCE) at the end of preclinical periodontal education to identify deficient areas for dental students in patient care and to explore factors affecting the probability of passing the OSCE.

METHODS

The summative OSCE was administered to two consecutive cohorts, Classes A (class of 2024; n1 = 134) and B (class of 2025; n2 = 129). The questions for each station in the OSCEs were available to both classes 1 week before the OSCEs. Descriptive statistics were used to identify deficient areas. The multiple logistic regression model was built to predict the probability of passing the OSCE based on the cohort, gender, and the practical and written examination scores.

RESULTS

Fifty-one (38%) students in Class A and 66 (51%) students in Class B completed the OSCE by passing all stations. Students undergoing remediation showed deficiencies in demonstrating how to detect tooth mobility, performing periodontal probing, drawing the healthy positive bony architecture and the mucogingival junction, and using a universal and a Gracey 13/14 curette. The probability of passing the OSCE was significantly correlated with Class B (p = 0.035) and the practical examination score (p = 0.03) while not associated with gender (p = 0.53) and the written examination score (p = 0.11).

CONCLUSION

Students showed deficiencies in assessment skills at the end of preclinical education. The study findings suggest that the implementation of the OSCE at the conclusion of preclinical education would be beneficial since the written examination score might not accurately reflect student readiness for clinical patient care.

The Impact of Script Concordance Testing on Clinical Decision-Making in Paramedic Education

This study investigates the effectiveness of the Script Concordance Test (SCT) in enhancing clinical reasoning skills within paramedic education. Focusing on the Medical University of Lublin, we evaluated the SCT's application across two cohorts of paramedic students, aiming to understand its potential to improve decision-making skills in emergency scenarios. Our approach, informed by Van der Vleuten's assessment framework, revealed that while the SCT's correlation with traditional methods like multiple-choice questions (MCQs) was limited, its formative nature significantly contributed to improved performance in summative assessments. These findings suggest that the SCT can be an effective tool in paramedic training, particularly in strengthening cognitive abilities critical for emergency responses. The study underscores the importance of incorporating innovative assessment tools like SCTs in paramedic curricula, not only to enhance clinical reasoning but also to prepare students for effective emergency responses. Our research contributes to the ongoing efforts in refining paramedic education and highlights the need for versatile assessment strategies in preparing future healthcare professionals for diverse clinical challenges.

Correlation Between Student Performances on Case-Based Constructed-Response Formative Assessment and Summative Assessment

OBJECTIVES

This study aimed to evaluate the impact of formative assessment with case-based constructed-response question (CRQ) formats on student performance on the final summative assessment in the second-year periodontics course.

METHODS

Classroom quizzes with case-based CRQs were implemented as the formative assessment during the course. Each student received feedback on their responses from the course director. After all students (N = 128) took the second-year final examination, the Friedman test was conducted to compare student performances in each assessment over time. The multiple linear regression (MLR) model was used to evaluate the association between the second-year final examination score and plausible predictors-student gender, the second-year formative and midterm examination scores, and time spent on the final examination.

RESULTS

The mean % scores in the formative assessment (51) and midterm (84) examination were significantly lower than that of the final (87) examination (P < .01). The number of students who failed the final (6) examination was significantly lower than the midterm (16) examination (P = .03). The midterm (P < .0001) and the formative assessment (P = .0009) scores significantly affected the second-year final examination score while student gender (P = .59) and time spending (P = .83) showed no correlations.

CONCLUSION

Within the limitations of the study, student performance on case-based CRQs was correlated with student performance on the summative assessment.

Three Psychometric-Model-Based Option-Scored Multiple Choice Item Design Principles that Enhance Instruction by Improving Quiz Diagnostic Classification of Knowledge Attributes

Three IRT diagnostic-classification-modeling (DCM)-based multiple choice (MC) item design principles are stated that improve classroom quiz student diagnostic classification. Using proven-optimal maximum likelihood-based student classification, example items demonstrate that adherence to these item design principles increases attribute (skills and especially misconceptions) correct classification rates (CCRs). Simple formulas compute these needed item CCRs. By use of these psychometrically driven item design principles, hopefully enough attributes can be accurately diagnosed by necessarily short MC-item-based quizzes to be widely instructionally useful. These results should then stimulate increased use of well-designed MC item quizzes that target accurately diagnosing skills/misconceptions, thereby enhancing classroom learning.

Feedback, fairness, and validity: effects of disclosing and reusing multiple-choice questions in medical schools

BACKGROUND

Disclosure of items used in multiple-choice-question (MCQ) exams may decrease student anxiety and improve transparency, feedback, and test-enhanced learning but potentially compromises the reliability and fairness of exams if items are eventually reused. Evidence regarding whether disclosure and reuse of test items change item psychometrics is scarce and inconclusive.

METHODS

We retrospectively analysed difficulty and discrimination coefficients of 10,148 MCQ items used between fall 2017 and fall 2019 in a large European medical school in which items were disclosed from fall 2017 onwards. We categorised items as 'new'; 'reused, not disclosed'; or 'reused, disclosed'. For reused items, we calculated the difference from their first ever use, that is, when they were new. Differences between categories and terms were analysed with one-way analyses of variance and independent-samples t tests.

RESULTS

The proportion of reused, disclosed items grew from 0% to 48.4%; mean difficulty coefficients increased from 0.70 to 0.76; that is, items became easier, P < .001, η_p² = 0.011. On average, reused, disclosed items were significantly easier (M = 0.83) than reused, not disclosed items (M = 0.71) and entirely new items (M = 0.66), P < .001, η_p² = 0.087. Mean discrimination coefficients increased from 0.21 to 0.23; that is, item became slightly more discriminating, P = .002, η_p² = 0.002.

CONCLUSIONS

Disclosing test items provides the opportunity to enhance feedback and transparency in MCQ exams but potentially at the expense of decreased item reliability. Discrimination was positively affected. Our study may help weigh advantages and disadvantages of using previously disclosed items.

First steps of learning analytics in a blended learning general practice curriculum at Saarland University - a quantitative approach

Objectives

Medical education has been revolutionized by the growing importance of digital learning. Little is known about students' online study behaviour and its relationship with exam performance. This quantitative study analyses and describes students' digital learning behaviours in a blended learning curriculum for General practice at Saarland University, Germany. It also examines the relationship between digital learning behaviour and exam performance.

Methods

Cohort and individualized AMBOSS® user data from 195 students at Saarland University was analysed quantitatively. Performance in course-specific multiple-choice question sessions and user data of the integrated online learning activities were correlated with each other and with General practice exam grades. Anonymized data from 10,534 students from 35 other German universities served as the reference cohort. Differences in digital learning behaviour between the groups were calculated using Mann-Whitney-U-Test for non-normally distributed data.

Results

Students in the blended learning course used integrated content more frequently than the reference cohort (U=48777, p<0.001). The number of digital learning cards read correlated moderately with digital formative assessment performance (ρ=0.331, p=0.005 and ρ=0.217, p=0.034). Formative assessment scores and exam results correlated strongly in the summer semester cohort (ρ=0.505, p<0.001), and moderately in the winter semester cohort (ρ=0.381, p<0.001).

Conclusion

There is a difference in the usage of online learning activities when they are purposefully integrated into a curriculum. Digital learning activities including formative assessment may serve as valuable, constructively aligned exam preparation. This is relevant for medical educators when planning future blended learning curricula and portfolio systems, as it may save financial and human resources.

A Team-based Learning Approach During Pediatric Clerkship to Promote Clinical Reasoning

BACKGROUND

Clinical reasoning skills are essential to medical practice. The problem lies in assuming junior medical students with limited experience develop clinical reasoning and decision-making skills passively and solely through clinical exposure. To prepare learners for independent practice and care for future patients, explicit teaching and assessment of clinical reasoning in low-stakes, collaborative learning environments are needed.

METHODS

The key-feature question (KFQs) format is an assessment approach that focuses on the reasoning and decision-making aspects of medical problems rather than knowledge recall. This report describes the development, implementation, and evaluation of a team-based learning (TBL) approach using KFQs to foster clinical reasoning in the third-year pediatric clerkship at our institution.

RESULTS

Over the first 2 years of implementation (2017-18, 2018-19), 278 students participated in TBL sessions. Mean individual student scores significantly improved in the group setting for both academic years (P < .001). Individual scores were moderately positively correlated with their total summative Objective Structured Clinical Examination score (r[275] = 0.51; P < .001). The correlation between individual score and their multiple-choice question examination was weaker at 0.29 (P < .001) but remained positive.

CONCLUSIONS

A TBL session using KFQs to both teach and assess clinical reasoning in clerkship students may help educators identify students with gaps in knowledge and/or reasoning. The next steps include developing and implementing individualized coaching opportunities, and expanding this approach within the undergraduate medical curriculum. Outcome measures to assess clinical reasoning in authentic patient encounters require further research and development.

Designing formative assessments to improve anatomy exam performance

Formative assessments are primarily used as a tool to gauge learning throughout an anatomy course. They have also been demonstrated to improve student mastery and exam performance, although the precise nature of this relationship is poorly understood. In this study, it is hypothesized that formative assessment questions targeting higher cognitive levels, integrating topics from multiple lessons, and including visuospatial elements will increase student exam performance. Formative and summative questions provided to students during the Clinical Anatomy block at the University of Arizona College of Medicine-Phoenix between 2015 and 2018 were assessed for cognitive level, integration of targeted learning objectives, and presence or absence of visuospatial elements. These variables were entered into a hierarchical linear model along with demographic variables for each cohort to assess the relationships between these variables and cohort performance on exam questions. The best predictor of exam performance was the inclusion of constituent learning objectives within the formative assessment. Additionally, students performed better on exam questions with visuospatial elements when the targeted learning objectives were also associated with visuospatial elements on the formative assessment. Surprisingly, the cognitive level of formative questions and the integration of learning objectives within them were not correlated with student exam performance. This study demonstrates the importance of including a broad range of topics in formative assessments and highlights a potential benefit of adopting consistent question formats for formative assessments and exams.

Automated feedback and writing: a multi-level meta-analysis of effects on students' performance

Introduction

Adaptive learning opportunities and individualized, timely feedback are considered to be effective support measures for students' writing in educational contexts. However, the extensive time and expertise required to analyze numerous drafts of student writing pose a barrier to teaching. Automated writing evaluation (AWE) tools can be used for individual feedback based on advances in Artificial Intelligence (AI) technology. A number of primary (quasi-)experimental studies have investigated the effect of AWE feedback on students' writing performance.

Methods

This paper provides a meta-analysis of the effectiveness of AWE feedback tools. The literature search yielded 4,462 entries, of which 20 studies (k = 84; N = 2, 828) met the pre-specified inclusion criteria. A moderator analysis investigated the impact of the characteristics of the learner, the intervention, and the outcome measures.

Results

Overall, results based on a three-level model with random effects show a medium effect (g = 0.55) of automated feedback on students' writing performance. However, the significant heterogeneity in the data indicates that the use of automated feedback tools cannot be understood as a single consistent form of intervention. Even though for some of the moderators we found substantial differences in effect sizes, none of the subgroup comparisons were statistically significant.

Discussion

We discuss these findings in light of automated feedback use in educational practice and give recommendations for future research.

Formative assessment and student understanding of structure-function

The structure and function relationship is a core concept identified by physiology faculty. Prior research has shown this may be a difficult concept for students to understand. Formative written assessments, such as short answer essay questions, allow students to demonstrate their thinking by encouraging students to use their diverse ideas to construct their responses. Varying the context of a question, such as the inclusion of a scenario, may be used to provide insight into the different stages of students' emerging biological expertise. Short answer questions based on the core concept structure↔function were administered to students in a junior level General Physiology course and a sophomore level Human Anatomy and Physiology course at a large southeastern public university. Questions were based on the integumentary, muscular, digestive and cardiovascular systems. Student responses were scored with a conceptual rubric developed for each question prompt as well as each organ system represented in the question prompts. Students were interviewed to determine if their responses to the short answer questions accurately reflected their thinking. Less than half of the student responses in this study demonstrated conceptual understanding of the structure-function relationship. Students demonstrated different conceptual understanding of structure↔function concepts depending on the question prompt with a scenario versus question prompt without a scenario. The question prompts with scenarios versus non-scenarios provided a different context which may have influenced student explanations. These results suggest that instructors should provide students with questions in varying contexts to allow students to demonstrate their heterogeneous ideas about a concept.Formative.

Using Test Question Templates to teach physiology core concepts

The past ∼15 years have seen increasing interest in defining disciplinary core concepts. Within the field of physiology, Michael, McFarland, Modell, and colleagues have published studies that defined physiology core concepts and have elaborated many of these as detailed conceptual frameworks. With such helpful definitions now in place, attention is turning to the related issue of how to maximize student understanding of the core concepts by linking these "big ideas" to concrete student-facing resources for active learning and assessment. Our practitioner-based view begins with the recognition that in many if not most undergraduate physiology courses assessment drives learning. We have therefore linked published conceptual frameworks to Test Question Templates (TQTs), whose structure promotes transparent assessments as well as the active learning needed to prepare for such assessments. We provide examples of conceptual framework-linked TQTs for the physiology core concepts of Homeostasis, Flow Down Gradients, the Cell Membrane, and Cell-Cell Communication. We argue that this deployment of TQTs has at least two distinct benefits for the teaching and learning of core concepts. First, documenting the connections between conceptual frameworks and TQTs may clarify coverage and assessment of the core concepts for both instructors and students. Second, misconceptions about core concepts may be directly targeted and dispelled via thoughtful construction, arrangement, and iteration of TQTs. We propose that the TQT framework or similar approaches may be applied fruitfully to any sufficiently articulated physiology core concept for high school, undergraduate, or graduate students.NEW & NOTEWORTHY Our students often focus on the grades they need to advance through academic programs. How can instructors harness this understandable interest in grades to help students gain a true understanding of core concepts? The new framework of Test Question Templates (TQTs) shows promise in linking student priorities like test scores to instructor priorities like core concepts.

Student Perceptions of a Framework for Facilitating Transfer from Lessons to Exams, and the Relevance of This Framework to Published Lessons

A main goal of academic courses is to help students acquire knowledge and skills that they can transfer to multiple contexts. In this article, we (i) examine students' responses to test question templates (TQTs), a framework intended to facilitate transfer, and (ii) determine whether similar transfer-promoting strategies are commonly embedded in published biology lessons. In study 1, in surveys administered over several academic quarters, students consistently reported that TQTs helped them transfer course content to exams and the real world; that multiple (two to five) examples were generally needed to understand a given TQT, leading >40% students to create their own additional examples; and that TQTs would be helpful in other science courses. In study 2, among 100 peer-reviewed lessons published by CourseSource or the National Center for Case Study Teaching in Science (NCCSTS), less than 5% of lessons gave students advice about exams or helped students create additional practice problems. The latter finding is not meant as criticism of these excellent lessons, which are a boon to the biology education community. However, with TQT-like prescriptions generally absent from peer-reviewed lessons, biology instructors may wish to supplement the lessons with TQT-like strategies to explicitly connect the material to subsequent exams.

Students' Perception of Formative Assessment as an Instructional Tool in Competency-Based Medical Education: Proposal for a Proof-of-Concept Study

BACKGROUND

In competency-based medical education (CBME), "Assessment for learning" or "Formative Assessment" (FA) plays a key role in augmenting student learning. FAs help students to measure their progress over time, enabling them to proactively improve their performance in summative assessments. FAs also encourage students to learn in a way where they address their knowledge gaps and gaps in their conceptualization of the subject matter. The effectiveness of an FA, as a learning and development instrument, relies on the degree of student involvement in the corresponding educational intervention's design and implementation. The extent of students' engagement in FA can be evaluated by appraising their perception regarding the educational intervention itself.

OBJECTIVE

This proof-of-concept study aims to develop a systemic understanding of a Formative Assessment as an Instructional Tool (FAIS) implemented in a biochemistry course in the Basic Medical Sciences component of an undergraduate entry, CBME.

METHODS

The educational intervention in question is an FAIS, which is implemented in a biochemistry course in the first semester of a 6-year bachelor of medicine, bachelor of surgery program. When developing the FAIS, each area of knowledge, skills, and attitudes were considered. Assessment formats are developed per Miller's learning pyramid. This multiphase study is meant to rely on a convergent mixed methods design, where qualitative and quantitative data are independently collected and analyzed. Thereafter, the outputs of analyses are systematically merged using joint display analysis process. Qualitative data are collected through a focus group session that captures the students' perception toward the FAIS. Data collection, integral to this focus group session, is exploratory. The inductive qualitative data analysis follows Braun and Clarke's 6-step framework. The quantitative component of this study revolves around investigating the effect of the FAIS on the course's summative assessment. The summative assessment performance of the 71 students, enrolled in the FAIS cohort, will be compared to that of the students in the non-FAIS cohort. The total duration of the proposed multiphase research study is 6 months.

RESULTS

This proposed multiphase study is expected to showcase, from a systemic perspective, the effectiveness of the respective educational intervention. It will shed light on the participating students' attitudes in relation to the usefulness of FA in achieving competency goals and in fostering self-directed learning. The proposed study could also uncover the hypothesized association between the FA intervention and enhanced performance in summative assessments.

CONCLUSIONS

Our findings will generate evidence regarding the application of FAs, which can be leveraged by other medical educators in contexts similar to those under investigation.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/41626.

Real-life scenario blended teaching approach for nurturing inquisitive learning of central nervous system in medical students

Among the various systems taught in the preclinical phases, the nervous system is more challenging to learn than other systems. In this report, a novel teaching methodology, "real-life scenario (RLS) blended teaching," is described and its effectiveness in facilitating inquisitive learning in undergraduate medical students is evaluated. This mixed-method study was conducted among three groups (group 1, n = 83; group 2, n = 85; and group 3; n = 79) of undergraduate medical students (18-20 yr) in the neurology and behavioral sciences module. RLS was presented to students in the form of demonstrations, role-plays, videos, and group activities. Group 1 students underwent traditional teaching-learning sessions. Group 2 students underwent RLS blended sessions and were provided with multiple miniassignments in a vignette format. Group 3 students received RLS blended sessions, multiple miniassignments, peer discussions, multiple formative assessments, and facilitator feedback sessions. The student performances on different exams were compared in terms of their group, and their perceptions of RLS were documented. Students exposed to RLS sessions blended with multiple assignments, peer discussions, multiple formative assignments, and facilitator feedback sessions performed well in the final summative assessments (67.87%) compared with those exposed to RLS sessions and assignments (50.21%) or exposed to traditional teaching alone (50.34%). RLS sessions increased students' curiosity and motivated them to learn the subject well. RLS sessions stimulated student interest and facilitated their learning. RLS along with effective use of multiple assignments, formative assessments, and/or feedback sessions significantly improved student learning. This demonstrates the effectiveness of this active method in teaching various subjects with appropriate modifications.NEW & NOTEWORTHY In this report, a novel teaching methodology, "real-life scenario (RLS) blended teaching" is described and its effectiveness in facilitating inquisitive learning in undergraduate medical students is evaluated. Students exposed to RLS sessions blended with multiple miniassignments, peer discussions, multiple formative assignments, and facilitator feedback sessions performed well in the summative assessments compared with those exposed to RLS sessions and assignments or exposed to traditional teaching alone. Students preferred active teaching-learning techniques over the traditional method.

Correlative and Comparative Study Assessing Use of a Mock Examination in a Pharmaceutical Calculations Course

Objective. Faculty at Massachusetts College of Pharmacy and Health Sciences University's School of Pharmacy-Worcester/Manchester are engaged in continuous quality improvement of their teaching and assessment methods to prepare students for successful careers in pharmacy. This study evaluated the impact of a formative mock examination on student performance on a main summative examination (main examination) administered during the spring 2020 semester of a pharmaceutical calculations course.Methods. A retrospective analysis of student test scores in a summative assessment (main examination) was performed across two cohort years (2019 and 2020) during which students were not administered and administered a formative mock exam, respectively. Central tendency and comparative analysis measures were performed to assess differences in student performance.Results. Out of 237 students enrolled, 221 students participated in the optional mock exam, and all 237 students participated in the main examination, with average scores for the mock examination and the main examination being 67% and 94%, respectively. Ninety-two students who received a grade C or better on their mock examination had a main examination average score (98%) that was significantly higher than those who received a D or F (n=129, main average score of 92%). Further, the average score in the 2020 examination was significantly higher when compared to the 2019 examination when no mock examination was offered (94% vs 77%, respectively).Conclusion. This was a descriptive, cross-sectional study to understand the differences in student performance in a summative assessment across two cohort years with and without a formative mock assessment. The results demonstrate that the formative mock examination was correlated with better performance among students but did not establish a causal relationship.

Impact of Audience Response System in Enhancing Teaching of Anatomy and Physiology for Health Sciences Students at King Saud bin Abdulaziz University for Health Sciences

Purpose

Instructional methods that offer students' opportunity for engagement are essential to develop an active learning environment. This paper aims (1) to assess whether the use of an Audience Response System (ARS) during anatomy and physiology lectures improves students' engagement, knowledge retention and academic achievement and (2) to evaluate the feasibility of introducing ARS as a formative tool from both instructors' and students' perspectives.

Materials and Methods

This quasi-experimental study was conducted across ten lectures for the second-year Pre-Applied Medical Science (PAMS) and Pre-Medical (PMED) students at the College of Sciences and Health Professions, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia. The ARS was integrated into five lectures, whereas the remaining were conducted without ARS. A comparison of the immediate post-lecture and prior laboratory session quiz scores between the lectures with and without ARS was performed using an independent sample t-test. An online survey was completed by the students as well as informal feedback was taken from the instructors to assess ARS usefulness.

Results

A total of 65 PMAS and 126 PMED students participated in the study. Students achieved significantly better scores for ARS lectures than non-ARS lectures: PAMS (p 0.038) and PMED (p 0.018). Students and instructors agreed that ARS was easy to use, allowing students to engage and actively participate in the teaching process by responding to questions and receiving instant and anonymous feedback about their learning progress.

Conclusion

Employing suitable interactive teaching methods facilitates students' learning and improves their retention of knowledge. Students and instructors positively view the ARS strategy as a means to promote learning in a traditional lecture setting. Increased practice on how to integrate its use into classrooms could lead to further utilization.

Continuous norming in learning progress monitoring-An example for a test in spelling from grade 2-4

One of the main goals of the teacher and the school system as a whole is to close learning gaps and support children with difficulties in learning. The identification of those children as well as the monitoring of their progress in learning is crucial for this task. The derivation of comparative standards that can be applied well in practice is a relevant quality criterion in this context. Continuous normalization is particularly useful for progress monitoring tests that can be conducted at different points in time. Areas that were not available in the normalization sample are extrapolated, closing gaps in applicability due to discontinuity. In Germany, teachers participated in a state-funded research project to formatively measure their children's spelling performance in primary school. Data (N = 3000) from grade two to four were scaled, linked and translated into comparative values that can be used in classrooms independently from specific times. The tests meet the requirements of item response models and can be transferred well to continuous norms. However, we recommend using the 10th or 20th percentile as cut-off points for educational measures, as the 5th percentile is not discriminating enough.

Wet Laboratory Training in Ophthalmology as a Tool for Formative Assessment

Surgical skills training and assessment have always remained a critical issue for both trainees and trainers. Ophthalmology being a microsurgical specialty, its training in the operating theater further faces a lot of challenges. Wet laboratory training and simulation training were, therefore, developed so that residents acquired certain basic skills in controlled laboratory settings before they could operate on patients and patient safety could thereby be ensured. Unfortunately, most literature focuses on the benefits such practice has on operating room performance; but not much attention has been paid to the use of such training for formative assessment, feedback, and its importance in effective learning. In this article, we highlight the challenges faced in surgical skill transfer and also give an insight into how wet or dry laboratory training can be of formative value in postgraduate training.

The Use of a Modified Script Concordance Test in Clinical Rounds to Foster and Assess Clinical Reasoning Skills

The development of clinical reasoning skills is a high priority during clinical service, but an unpredictable case load and limited time for formal instruction makes it challenging for faculty to foster and assess students' individual clinical reasoning skills. We developed an assessment for learning activity that helps students build their clinical reasoning skills based on a modified version of the script concordance test (SCT). To modify the standard SCT, we simplified it by limiting students to a 3-point Likert scale instead of a 5-point scale and added a free-text box for students to provide justification for their answer. Students completed the modified SCT during clinical rounds to prompt a group discussion with the instructor. Student feedback was positive, and the instructor gained valuable insight into the students' thought process. A modified SCT can be adopted as part of a multimodal approach to teaching on the clinic floor. The purpose of this article is to describe our modifications to the standard SCT and findings from implementation in a clinical rounds setting as a method of formative assessment for learning and developing clinical reasoning skills.

The effectiveness of formative assessment for enhancing reading achievement in K-12 classrooms: A meta-analysis

This quantitative synthesis included 48 qualified studies with a total sample of 116,051 K-12 students. Aligned with previous meta-analyses, the findings suggested that formative assessment generally had a positive though modest effect (ES = + 0.19) on students' reading achievement. Meta-regression results revealed that: (a) studies with 250 or less students yielded significantly larger effect size than large sample studies, (b) the effects of formative assessment embedded with differentiated instruction equated to an increase of 0.13 SD in the reading achievement score, (c) integration of teacher and student directed assessment was more effective than assessments initiated by teachers. Our subgroup analysis data indicated that the effect sizes of formative assessment intervention on reading were significantly different between Confucian-heritage culture and Anglophone culture and had divergent effective features. The result cautions against the generalization of formative assessment across different cultures without adaptation. We suggest that effect sizes could be calculated and intervention features be investigated in various cultural settings for practitioners and policymakers to implement tailored formative assessment.

Revisiting Clickers: In-Class Questions Followed by At-Home Reflections Are Associated with Higher Student Performance on Related Exam Questions

Clicker questions are a commonly used active learning technique that stimulates student interactions to help advance understanding of key concepts. Clicker questions are often administered with an initial vote, peer discussion, and a second vote, followed by broader classroom explanation. While clickers can promote learning, some studies have questioned whether students maintain this performance on later exams, highlighting the need to further understand how student answer patterns relate to their understanding of the material and to identify ways for clickers to benefit a broader range of students. Systematic requizzing of concepts during at-home assignments represents a promising mechanism to improve student learning. Thus, we paired clicker questions with at-home follow-up reflections to help students articulate and synthesize their understandings. This pairing of clickers with homework allowed us to decipher how student answer patterns related to their underlying conceptions and to determine if revisiting concepts provided additional benefits. We found that students answering both clicker votes correctly performed better on isomorphic exam questions and that students who corrected their answers after the first vote did not show better homework or exam performance than students who maintained an incorrect answer across both votes. Furthermore, completing the follow-up homework assignment modestly boosted exam question performance. Our data suggest that longer-term benefits of clickers and associated homework may stem from students having repeated opportunities to retrieve, refine, and reinforce emerging conceptions.

Students' perception on flipped classroom with formative assessment: A focus group study

OBJECTIVE

To explore students' perception on the implementation of flipped classroom (FC) combined with formative assessment during the undergraduate teaching of orthodontic wire-bending skills.

METHODS

Third-year undergraduate dental students were taught wire-bending skills via FC teaching method using a series of pre-recorded online video demonstrations. As part of the formative assessment, the students were given the results and assessment rubrics of their prior wire-bending assessment before every subsequent session. Purposive sampling method for focus group discussion was used to recruit eight students comprising four high achievers and four low achievers. Strengths, weaknesses and suggestions for improvement of the FC with formative assessment were explored. Data were transcribed and thematically analysed.

RESULTS

Students perceived that FC allowed for a more convenient and flexible learning experience with personalised learning and improved in-class teaching efficiency. The pre-recorded online videos were useful to aid in teaching wire-bending skills but lacked three-dimensional representation of the wire-bending process. Students suggested better standardisation of instructions and access to the marking rubric before and after assessment.

CONCLUSIONS

FC teaching with continuous formative assessment and constructive feedback as a form of personalised learning was viewed favourably by students. The implementation of periodic individual feedback can further enhance their learning experience.

Using quizzes to provide an effective and more enjoyable dental education: A pilot study

INTRODUCTION

Increasingly, dental education is using digital strategies to deliver teaching; however, not all of these learning materials are engaging and effective.

AIM

To evaluate the perception and knowledge retention of undergraduate dental students after using two different digital learning tools: quizzes and PDF.

METHODS

Thirty-three students from a Dental School in the United Kingdom took part in the research. They received learning material derived from the Prosthodontic (Kennedy classification) or Paediatric dentistry content (Tooth classification). The same content was delivered in two different formats: quiz game (n = 17) and PDF file (n = 16). The PDF file had ten images and their classifications, whilst the quiz had the same images with a question about the classification, along with alternatives (single best answer).

RESULTS

All students gave similar performances on the knowledge assessment; however, their perception about the learning material differed. Students using quizzes (88%) agreed that they were fun and an interesting way of learning, while only 37.5% had this opinion about PDF material (p = .002). When using quizzes, learners were more motivated and confident. They would frequently recommend quizzes to other colleagues; however, the use of PDF was not suggested as frequently (p = .039). As a learning strategy, 100% of the students using quizzes wanted more of the same to study other dental subjects. This was not the case with the PDF format (p = .005).

CONCLUSION

Despite quizzes and PDF files resulting in a similar understanding of dental subjects, learners prefer quizzes to supplement their studies. Educators should consider using this interactive digital tool to engage students, instead of PDF files.

Higher Education Students' Reflective Journal Writing and Lifelong Learning Skills: Insights From an Exploratory Sequential Study

Reflective journal (RJ) writing has been recognized as an effective pedagogical tool for nurturing students’ lifelong learning skills. With the paucity of empirical work on the dimensionality of reflective writing, this research sought to qualitatively analyze students’ RJ writing and design a generic reflection scheme for identifying dimensions of reflective thinking. Drawing on the theoretical scheme, another aim was to design and validate a questionnaire to measure students’ perceptions of their reflective writing experiences. The last aim was to quantitatively measure the link between perceived reflective writing and students’ tendency to use RJs in their future careers and personal lives. This exploratory sequential research included the following steps: First, experts’ review and analysis of 1312 RJ entries were attained. This step led to the design of a theoretical scheme of reflective writing and a 31-item questionnaire, used to gather data from 171 students (second-year pre-service teachers and third-year health managers). Partial Least Squares analysis corroborated the structure suggested by the theoretical scheme: two timelines–reflections regarding the current course assignments and those related to the student’s future development. Students’ tendency to use reflective skills in their future professional lives was highly connected to their long-term reflections, including learning experiences linked to academic, professional, personal, and multicultural development. The current study’s suggested validated generic scheme can be adapted and integrated into different curricula, thereby possibly increasing the potential of infusing RJ instructional strategies into higher education curricula, improving the quality of reflection in student journals, and promoting lifelong learning skills.

Formative vs. summative assessment: impacts on academic motivation, attitude toward learning, test anxiety, and self-regulation skill

As assessment plays an important role in the process of teaching and learning, this research explored the impacts of formative and summative assessments on academic motivation, attitude toward learning, test anxiety, and self-regulation skill of EFL students in Iran. To fulfill the objectives of this research, 72 Iranian EFL learners were chosen based on the convenience sampling method assigned to two experimental groups (summative group and formative group) and a control group. Then, the groups took the pre-tests of test anxiety, motivation, and self-regulation skill. Then, one experimental group was trained by following the rules of the formative assessment and the other experimental group was taught according to the summative assessment. The control group was instructed without using any preplanned assessment. After a 15-session treatment, the post-tests of the test anxiety, motivation, and self-regulation skill were administered to all groups to assess the impacts of the instruction on their language achievement. Lastly, a questionnaire of attitude was administered to both experimental groups to examine their attitudes towards the impacts of formative and summative assessment on their English learning improvement. The outcomes of one-way ANOVA and Bonferroni tests revealed that both summative and formative assessments were effective but the formative one was more effective on academic motivation, test anxiety, and self-regulation skill. The findings of one sample t-test indicated that the participants had positive attitudes towards summative and formative assessments. Based on the results, it can be concluded that formative assessment is an essential part of teaching that should be used in EFL instructional contexts. The implications of this study can help students to detect their own weaknesses and target areas that need more effort and work.

Understanding Formative Assessment Practice in the EFL Exam-Oriented Context: An Application of the Theory of Planned Behavior

Formative assessment (FA) has been used to facilitate EFL learning and teaching. However, due to factors such as task complexity and time constraints, FA implementation faces a variety of challenges, especially in countries with an exam-oriented education system. Drawing on the case of EFL teachers from Chinese public secondary schools, this study examines the features of FA practice and explains their underlying aspects in an EFL exam-oriented context from a social psychology perspective. It adopts a mixed-methods research approach. Guided by the theory of planned behavior, 10 English teachers from Guangdong province in China were interviewed to establish an item pool for a structured questionnaire. A total of 161 English teachers from four cities in Guangdong province took part in the subsequent survey. The results revealed that the participating teachers have an implicit understanding of FA, based primarily on its literal meaning and their own teaching experience. They know and follow FA methods but lack confidence about their own practice. Regional differences were significant. Possible reasons for the perceptions and practices of Chinese EFL teachers from public secondary schools are the teachers’ own attitudes, the influence of other stakeholders, and the limitations of the FA methods. The study elucidates the features of FA practice and its mechanism in an EFL exam-oriented context.

The periodontal senior case clinical challenge: Students' opinions of a formative virtual assessment during the COVID-19 emergency

INTRODUCTION

Due to COVID-19, innovative, virtual educational methods are being developed to provide students with learning experiences comparable to established clinical practices. Our objective was to produce the Periodontal Senior Case Clinical Challenge (PSCCC) that would provide fourth-year students an alternative for senior case presentations and would be a formative assessment for which student opinions would be provided and analysed. The PSCCC would utilise an online, case-based, written, clinical assessment and follow-up, structured discussion to challenge students to demonstrate ability to apply didactic periodontal knowledge to patient-based experiences. We hypothesised the PSCCC would provide effective learning and a formative assessment.

MATERIAL AND METHODS

Relevant didactic resources were distributed to 48 students for independent review. The PSCCC was delivered in two sections, (1) a case-based assessment via a virtual classroom with written student responses, and (2) oral discussions conducted via virtual meetings that were moderated and assessed by ten periodontists, with the collaboration of nine residents. A voluntary six-statement survey was used to evaluate the students' opinions of the PSCCC. The scores for 75% (36/48) of students who participated were evaluated for statistical and clinical importance.

RESULTS

The value of our PSCCC was supported by 91.7% (33/36) of the analyses (p < .0008).

DISCUSSION

The PSCCC was a successful alternative pathway to assess students' clinical and didactic integrated knowledge in periodontics. It provided a unified vision of treatment of the selected case, building on all aspects of the students' periodontal education whilst allowing interaction in a simultaneous, three-tiered educational approach, involving dental students, periodontal residents and faculty.

CONCLUSION

In support of our hypothesis, for each of the 6 statements, ≥94.44% (34/36) of the scores given by the students were considered exceptionally strong clinical support for our pedagogical strategy that combines educational resources and can be successfully implemented in other programmes.

Answering questions in a co-created formative exam question bank improves summative exam performance, while students perceive benefits from answering, authoring, and peer discussion: A mixed methods analysis of PeerWise

Multiple choice questions (MCQs) are a common form of assessment in medical schools and students seek opportunities to engage with formative assessment that reflects their summative exams. Formative assessment with feedback and active learning strategies improve student learning outcomes, but a challenge for educators, particularly those with large class sizes, is how to provide students with such opportunities without overburdening faculty. To address this, we enrolled medical students in the online learning platform PeerWise, which enables students to author and answer MCQs, rate the quality of other students' contributions as well as discuss content. A quasi-experimental mixed methods research design was used to explore PeerWise use and its impact on the learning experience and exam results of fourth year medical students who were studying courses in clinical sciences and pharmacology. Most students chose to engage with PeerWise following its introduction as a noncompulsory learning opportunity. While students perceived benefits in authoring and peer discussion, students engaged most highly with answering questions, noting that this helped them identify gaps in knowledge, test their learning and improve exam technique. Detailed analysis of the 2015 cohort (n = 444) with hierarchical regression models revealed a significant positive predictive relationship between answering PeerWise questions and exam results, even after controlling for previous academic performance, which was further confirmed with a follow-up multi-year analysis (2015-2018, n = 1693). These 4 years of quantitative data corroborated students' belief in the benefit of answering peer-authored questions for learning.

Learners' Perspective towards E-Exams during COVID-19 Outbreak: Evidence from Higher Educational Institutions of India and Saudi Arabia

Online examinations, commonly referred to as e-exams (electronic examinations), underwent a considerable progression, getting adapted ubiquitously among higher education institutions worldwide. Their preferment was rapid due to the emergence of the COVID-19 pandemic. The process of conducting exams online is being opted as the appropriate way of assessment, ensuring the students’ safety and well-being. According to Warts et al., this form of examination has been pretty effective in the past when blended with the conventional assessment. However, at present, implemented as the singular way of assessment, e-exams have shown a more significant promise in being beneficial to the learners. As a matter of fact, a comprehensive analysis on understanding the learners’ perception towards the e-exams was not done earlier, particularly in the developing nations. Thus, it was pertinent to examine the pre-requisites of e-exams to promote it as a useful tool for the smooth conduct of exams in the aforesaid nations. Against such a backdrop, this study was conducted during January to March 2021 on 207 students enrolled in four universities, three situated in the National Capital Territory (NCT) of Delhi, India: Delhi University (DU), Jamia Millia Islamia (JMI), and Jawaharlal Nehru University (JNU), and one situated in Saudi Arabia, namely Saudi Electronic University (SEU). A quantitative approach was employed for the study, with the responses recorded via web questionnaires. Confirmatory -factor analysis (CFA) was applied in the study to examine whether the process of conducting online examinations is being chosen as the appropriate form of assessment, ensuring the safety and well-being of students through AMOS (version 24) software. For determining the reliability of the two latent constructs, namely “Perceptions of students towards E-exams (PSE)” and “Pre-requisites of E-exams (POE),” Cronbach’s alpha was used through SPSS (version 25) software in the study, and the results reveal that the strong internal consistency exists between all the measured variables. In addition, the mean and standard deviation were used by the researchers to find out the pre-requisites of the online examination system. The participants expressed their insights on the relative benefits of online examination. Their perception was based on pedagogy, validity and reliability, affective factors, practicality, and security. From their insights, it was concluded that online examination is more advantageous than conventional paper-based exams. The outcome also applies to the authenticity of grading and the overall efficiency concerning the time, effort, and expenditure on conducting the examination. Contrarily, the participating students also recognized numerous hurdles in implementing e-exams concerning security, validity, and impartiality. The conclusion further revealed that online examination is especially relevant for formative assessment of learning instead of summative assessment, provided authenticity, security, and flexibility are used as fundamental tenants in the proper implementation of e-exams. The outcome of the present study will facilitate higher education institutions and policymakers in taking the electronic examination system to the next level.

The effect of live demonstration and flipped classroom with continuous formative assessment on dental students' orthodontic wire-bending performance

BACKGROUND

Wire-bending skills is commonly taught through live demonstrations (LD) though flipped classroom (FC) method has gained popularity. Continuous formative assessment promotes personalised learning via closely monitored progress, with the identification of students' strengths and weaknesses. This study aims to evaluate the effects of LD and FC teaching methods, supplemented with continuous formative assessment, on dental students' learning of wire-bending skills for six types of removable orthodontic appliance components. A deeper understanding of the relative effectiveness between LD and FC teaching methods can help identify the most appropriate method to achieve student learning objectives, which is especially important given the current Covid-19 pandemic.

METHODS

Forty third-year undergraduate dental students were randomly assigned into FC (n = 20) or LD (n = 20) cohort. Each student attended six teaching sessions, each to teach students' competency in fabricating one type of wire component, for a total competency in fabricating six wire components over the course of six teaching sessions. Either LD or FC teaching methods were used. After each session, wire assignments had to be submitted. Wire assignments were then evaluated using a blinded wire-bending assessment protocol. As part of their formative assessment, the assessment results were distributed to students, lecturers, and technicians before the next session. After the first session (T0) and at the end of all six sessions (T1), students completed a self-reported questionnaire.

RESULTS

The mean wire-bending scores for FC were significantly higher than LD for two of the six assignments, namely the Adams clasp (p < 0.01) and Z-spring (p = 0.03). Scores for both LD and FC increased significantly over time, which may be attributed to formative assessment. There was no statistically significant correlation between wire-bending scores and video usage. Students were satisfied with both teaching methods, according to T0 and T1 questionnaires.

CONCLUSIONS

Both LD and FC are equally effective in transferring practical orthodontic wire-bending skills and well-received by students. Continuous formative assessment may have enhanced students' learning of orthodontic wire-bending skills. Further studies with control group are recommended to investigate the effect of formative assessment on teaching practical dental skills.

Transitioning to Web-Based Learning in Basic Life Support Training During the COVID-19 Pandemic to Battle the Fear of Out-of-Hospital Cardiac Arrest: Presentation of Novel Methods

Ongoing training in the area of basic life support aims to encourage and sustain the willingness to act in out-of-hospital cardiac arrest situations among first aiders. The contribution of witnesses and first aiders has diminished rapidly, as suspicion associated with the COVID-19 pandemic has risen. In this paper, we present teaching methods from the medical education field to create a new teaching-learning process for sustaining the prehospital involvement of first aiders and encourage new first aiders. The most important benefit-improving outcomes-can be achieved by introducing a variety of teaching-learning methods and formative assessments that provide participants with immediate feedback to help them move forward in the basic life support course. The new reality of web-based learning that has been introduced by the pandemic requires an innovative approach to traditional training that involves techniques and methods that have been proven to be useful in other fields.

Students' Perceptions of Instructional Rubrics in Neurological Physical Therapy and Their Effects on Students' Engagement and Course Satisfaction

One of the main challenges faced by physical therapy (PT) students is to learn the practical skills involved in neurological physical therapy (PT). To help them to acquire these skills, a set of rubrics were designed for formative purposes. This paper presents the process followed in the creation of these rubrics and their application in the classroom, noting that students perceived them as valid, reliable, and highly useful for learning. The perception of the validity and usefulness of the rubrics has different closely related dimensions, showing homogeneous values across the students´ sociodemographic and educational variables, with the exception of dedication to studying, which showed a significant relationship with schoolwork engagement and course satisfaction. The adequacy of the hypothesized structural model of the relationships among the variables was confirmed. Direct effects of the perception of the rubrics' validity and engagement on course satisfaction were found, as well as direct effects of the assessment of the usefulness of the rubrics on schoolwork engagement and indirect effects on course satisfaction through this latter variable. The results are discussed taking into account the conclusions of previous research and different instructional implications.

Evaluation of e-OSPE as compared to traditional OSPE: A pilot study

Objectively Structured Clinical/Practical Examination (OSCE/OSPE) has been the backbone of the assessment system of graduate medical education for over three decades. We have developed an electronic Objectively Structured Practical Examination (e-OSPE) in Medical Biochemistry using the freely available Google forms to mitigate the academic disruption posed by COVID-19 pandemic in our resource-poor setting. Ten e-OSPE stations created, interlinked, and time-restricted. Fifty undergraduate students appeared for the e-OSPE examination on a prefixed date and time. Learner feedback was collected immediately after the completion of the examination. Facilitator feedback was also collected. Students' mean scores in e-OSPE and traditional OSPE were 78.15% and 74.56%, respectively. Their difference was not statistically significant (paired t-test two-tailed p-value 0.0979). Thus, the results of e-OSPE are reliable as compared to traditional OSPE. Bland Altman Plot revealed 92% of students had scores that were in the agreeable limit of both traditional OSPE and e-OSPE. Both the learners and facilitators were in consensus that the online format of e-OSPE is a good alternative for assessment (0.67 and 0.82); their experience was good (0.72 and 0.92) and conduction was well organized (0.73 and 0.86). Several suggestions were also received to make e-OSPE even more effective. In conclusion, this pilot study showed e-OSPE can be an effective alternative to traditional OSPE when "in-person" evaluation is not possible such as in the current era of COVID-19 even in resource-limited settings.

Development of a Virtual Three-Dimensional Assessment Scenario for Anatomical Education

In anatomical education three-dimensional (3D) visualization technology allows for active and stereoscopic exploration of anatomy and can easily be adopted into medical curricula along with traditional 3D teaching methods. However, most often knowledge is still assessed with two-dimensional (2D) paper-and-pencil tests. To address the growing misalignment between learning and assessment, this viewpoint commentary highlights the development of a virtual 3D assessment scenario and perspectives from students and teachers on the use of this assessment tool: a 10-minute session of anatomical knowledge assessment with real-time interaction between assessor and examinee, both wearing a HoloLens and sharing the same stereoscopic 3D augmented reality model. Additionally, recommendations for future directions, including implementation, validation, logistic challenges, and cost-effectiveness, are provided. Continued collaboration between developers, researchers, teachers, and students is critical to advancing these processes.

Remedial Teaching and Learning From a Cognitive Diagnostic Model Perspective: Taking the Data Distribution Characteristics as an Example

In response to the big data era trend, statistics has become an indispensable part of mathematics education in junior high school. In this study, a pre-test and a post-test were developed for the six attributes (sort, median, average, variance, weighted average, and mode) of the data distribution characteristic. This research then used the cognitive diagnosis model to learn about the poorly mastered attributes and to verify whether cognitive diagnosis can be used for targeted intervention to improve students' abilities effectively. One hundred two eighth graders participated in the experiment and were divided into two groups. Among them, the intervention materials read by the experimental group students only contained attributes that they could not grasp well. In contrast, the reading materials of the control group were non-targeted. The results of the study showed the following: (1) The variance and the weighted average were poorly mastered by students in the pre-test; (2) compared with the control group, the average test score of the experimental group was significantly improved; (3) in terms of attributes, the experimental group students' mastery of variance and the weighted average was significantly improved than the pre-test, while the control group's mastery was not. Based on this, some teaching suggestions were put forward.

Medical students' perception of the reliability, usefulness and feasibility of unproctored online formative assessment tests

Medical education has gone online because of the COVID-19 pandemic. Formative assessment is essential to facilitate the learning process in medical education. However, various challenges arise during online assessment, which include reliability, when done without monitoring and practical concerns like Internet connectivity issues. This study was done to assess the medical students' perceptions of the reliability, usefulness, and practical challenges of online tests. One hundred first-year undergraduate medical students taking up online classes and tests in the subject of physiology were enrolled in this study. A questionnaire with items regarding practical challenges, reliability, and usefulness of the online tests, in general, and about different types of online assessment methods, in particular, were sent to the students online. Each item was rated on a five-point Likert scale, and the responses were analyzed anonymously. A large percentage of students used mobile phones (81.4%) to undertake online tests. Although most students (73.2%; P < 0.001) felt that online tests helped them substantially in learning the subject, network connectivity issues were considered to be a matter of serious concern (85.5%, P < 0.001). Among the assessment methods used, viva voce by video conferencing was thought to be most reliable (83%, P < 0.001). Multiple-choice question-based assessment when done online was felt to be more practically feasible with faster feedback than classroom assessment. The results of the study suggest that medical students find online formative assessments helpful for their learning, despite their concerns about reliability and practical challenges.

Satisfying Program-Level Outcomes by Integrating Primary Literature into the Online Classroom

Because of the coronavirus pandemic, there has been a paradigm shift from traditional classroom instruction to remote online modalities. To provide the most current and relevant information on nuclear medicine technology to students without access to traditional resources on a college campus, it has become imperative that primary literature within the field be made readily accessible. Nuclear medicine technology students at Bronx Community College are being taught to use the Journal of Nuclear Medicine Technology as the basis for their required presentations, which span the curriculum. Guided by instructors who are armed with a rubric ultimately used as a formative assessment tool, the students are required to explore current articles from the Journal of Nuclear Medicine Technology and ultimately present their findings to their cohort. By design, this article-share project has successfully been implemented as a principal metric in satisfying the program accreditation requirements of the Joint Review Committee on Nuclear Medicine Technology while also being conducive to increasing oral presentation skills and cohort socialization.

The Attitudinal Style as Pedagogical Model in Physical Education

The continuous changes in the different legislative systems have led to the application of different ways of understanding students and generating learning in them. In this sense, an area such as physical education is not alien to the continuous changes in teaching learning and its teaching has been modified from a behavioural approach to more cognitive perspectives. In this line, the Attitudinal Style concept arises with the intention of responding to this need for evolution, a global approach to teaching, as well as the generation of materials that allow the participation and learning of all types of students, greatly favoring their involvement and/or adaptation. The objective of this study is to present the Attitudinal Style as a pedagogical model within school physical education, analyzing its characteristics, elements and main purposes. A systematic review of narrative character is used, showing the origins and fundamental elements to justify the Attitudinal Style as a pedagogical model. Thus, aspects such as the generation of positive experiences in the students; the rigorous explanation of what is being learned, adaptation to the content, context and students; the work of collaboration and/or cooperation as a means to achieve a group achievement; the transfer of learning; and the application of formative evaluation, make this model of teaching applicable, relevant and necessary in the different educational levels.

Use of an Adaptive e-Learning Platform as a Formative Assessment Tool in the Cardiovascular System Course Component of an MBBS Programme

BACKGROUND

Technology-enhanced learning includes the adaptive e-learning platform, a data-driven method with computer algorithms, providing customised learning enhancing critical thinking of individual learners. "Firecracker" - an online adaptive e-learning platform, and assessment software, promotes critical thinking, helps prepare students for courses and high-stakes examinations, and evaluates progress relative to co-learners. The objectives of this study were to determine the usage rates of Firecracker, examine the performance of Firecracker formative quizzes, identify the correlation between Firecracker use and performance with that of performance at summative course assessments, and assess students' satisfaction with Firecracker usage.

METHODS

Study participants were Year-2 MBBS (Bachelor of Medicine, Bachelor of Surgery) students (n=91) of the Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados. The Firecracker Administrator uploaded quizzes covering basic science content in the Cardiovascular System course. Access, usage, and performance on Firecracker formative quizzes were retrieved from the Firecracker dashboard. A questionnaire sought the views of study participants.

RESULTS

Seven sets of quizzes were administered over nine weeks, with weekly student completion rates ranging from 53% to 73%. Mean quiz scores ranged from 52% to 72%. Students completing >4 quiz sessions compared to those completing ≤4 demonstrated significantly better performance in Firecracker quizzes (P<0.01), final examinations (P<0.01) and in-course assessment plus final examination (P<0.05) scores. Correlations between overall Firecracker performance and in-course assessment marks (P<0.05); between total overall Firecracker performance and final examination (P<0.01); and overall Firecracker performance and total course marks (P<0.01) were all significant. Most students (70%) were happy using Firecracker and felt it complemented coursework (78%) and prepared them for course exams (58%) (P<0.01).

CONCLUSION

Overall, Firecracker was perceived very positively and welcomed by the students. Students were satisfied with the Firecracker as a formative assessment tool, and its use correlated with improved performance in the course examinations.

The evolution of anti-emetic prescriptions in primary care, between 2006 and 2016

CONTEXT

Serious adverse events related to the use of domperidone and metoclopramide have been consistently reported in the literature for many years. This led to a restriction of their use in the early 2010s.

OBJECTIVE

The main objective was to analyse the evolution of antiemetic prescription rate in French general practise between 2006 and 2016. The secondary objectives were to highlight prescription transfers for metopimazine and to quantify the impact on health expenditures.

METHOD

All patients from a representative sample of a national administrative claims database, the French national health insurance database, were included between 2006 and 2016. Trends in annual anti-emetic prescription rates by general practitioners were analysed using logistic regression models adjusted for age, gender and the existence of cancer. The cost of theses changing prescription habits was quantified via Médic'AM, a public drug expenditure database.

RESULTS

Around 669 020 individuals were included with a mean 8-year follow-up; 48 634 patients received an anti-emetic at least once between 2006 and 2016. Prescription rates for all antiemetics decreased significantly from 2.1% to 0.4%, especially for metoclopramide from 0.5% to 0.1%, for domperidone from 1.5% to 0.1% and for metopimazine from 0.4% to 0.2%, which is not in favour of prescription transfers. Expenses fell from 30 million euros in 2006 to 10 million in 2016.

CONCLUSION

Decreases in anti-emetic prescription rates and public health expenditures preceded the publication of official recommendations to reduce the use of metoclopramide and domperidone, without prescription transfers for metopimazine.

Impact of readiness assurance process and faculty feedback on individual application exercises: a model for continuous assessment in physiology

This study is aimed at the implementation of a continuous assessment model in physiology for a large-enrollment classroom with 250 students. The readiness assurance process (RAP) and immediate feedback elements from team-based learning (TBL) methodology were adopted to test their ability to guide students to solve applications exercises individually. Three continuous assessments in physiology (CAPs) were conducted with the RAP to include individual (iRAT) and group readiness assurance tests (gRAT). Immediate feedback was provided with faculty-student discussion (FSD), and the individual application exercises (iAE) were designed to be answered individually. Each CAP was subjected to three types of experimental manipulation in subgroups created out of 250 students. The intervention began with iRAT for all three subgroups. The sequence of iRAT, gRAT, FSD, and iAE varied between subgroups within a CAP. In a cross-over study design, each subgroup of students was subjected to all three intervention types over three CAPs. The subgroup completing iAE after RAP and FSD showed higher scores than the subgroup with RAP alone. One hundred eight-two students (82.35% response rate; 101 women and 81 men) responded to the questionnaire. The majority of students (87.4%) felt that doing iRAT and gRAT at the beginning helped them to solve iAE better. Most of the students (86.8%) responded that they received useful feedback and clarification during the discussion with the teacher after the gRAT. In conclusion, the administration of iRAT first followed by gRAT and immediate feedback from faculty seem to be beneficial to prepare students to tackle application-based exercises.

The effectiveness of formative assessment in pathophysiology education from students' perspective: a questionnaire study

Current interdisciplinary medical training calls for reforms and innovations in the assessment of pathophysiology education. Formative assessment is used to monitor student learning to provide ongoing feedback that can improve both learning and teaching. Beginning in 2016, we implemented a formative assessment composed of case-based multiple-choice questions (MCQs) for all students in all majors. In 2017, case study questions began to be employed in the formative assessment, and student-set, case-based questions were further introduced. Aiming to gather the students' suggestions and feedback on the mixed-method assessment, we conducted a survey on aspects such as the effectiveness of the assessment, assessment content and completion, opinions on student-set questions, and the impact on pathophysiology learning for students from 2017 to 2019. In addition, we compared students' semesterly final scores with those of previous students and evaluated the relationship between formative and summative assessment scores. The results for 1,277 students clearly showed that the reformed formative assessment system was well received by the students. The students thought that the formative assessment not only allowed for the provision of real-time feedback on the effectiveness of teaching and learning but also nurtured self-motivation, the development of analytical and problem-solving skills, and collaborative efforts. Both the semesterly final scores and the proportions of students scoring in higher score ranges increased after the implementation of the formative assessment, and the summative assessment scores were positively related to the formative assessment scores. Consequently, the reformed formative assessment system significantly improved the quality of pathophysiology education.

Patients' and parents' perspectives of and experiences with assessing nursing students' paediatric clinical practice

PURPOSE

To explore patients' and parents' involvement in the formative assessment of undergraduate nursing students' paediatric clinical practice.

METHODS

We conducted semi-structured interviews with paediatric patients between 14 to 18 years old and parents who received care from a nursing student while admitted to a paediatric tertiary care hospital in Canada. We analysed the data using qualitative content analysis as well as Lincoln and Guba's criteria for establishing trustworthiness. The Consolidated criteria for reporting qualitative studies (COREQ) checklist was completed for the quality appraisal of this article.

FINDINGS

Three categories emerged from the data: 1) how patients and parents are currently involved in the formative assessment of nursing students' paediatric clinical practice; 2) how patients and parents would prefer to be involved in the formative assessment of nursing students' paediatric clinical practice; and 3) the potential benefits and challenges of involving patients and parents in the formative assessment of nursing students' paediatric clinical practice.

CONCLUSION

This study provided an understanding of patients' and parents' past encounters with nursing students and the elements of care that they have assessed as well as those that they would prefer to assess and provide feedback on, while considering the potential benefits and challenges of their involvement. The findings of this study will assist clinical instructors in determining how and when to involve patients and parents in the assessment of nursing students. Academic institutions offering nursing programmes should consider the study findings when improving or changing formative assessment strategies.

12 TIPS for Implementing Peer Instruction in Medical Education

This article was migrated. The article was marked as recommended. Peer Instruction (PI) is a vibrant instructional strategy, used successfully for over two decades in undergraduate physics and mathematics courses. It has had limited use and few publications in medical education. This 12 TIPS provides a focused review on the evidence supporting its use in higher education and rationale for its wider adoption in medical education. The authors detail important steps for its implementation with large classes. Based on several years of experience with PI in a US allopathic medical school, they feel that PI attends to core principles from the science of learning and provides students and faculty with immediate feedback on learning. It is also adaptable to on-line synchronous administration.

Advantages of Kahoot! Game-based Formative Assessments along with Methods of Its Use and Application during the COVID-19 Pandemic in Various Live Learning Sessions

BACKGROUND

Technology has played important roles in education, thus the application of online Kahoot! Game-based technology as a learning tool particularly in formative assessments might improve learning and achieve promising education. It can be applied live, either face to face or virtual in distance learning as during the current situation of COVID-19 pandemic that resulted in total shift toward online learning.

METHODOLOGY

Kahoot! Game-based histology and cell biology lab formative assessments were prepared, equipped with light and electron microscopic photos, and applied for 2nd year undergraduate medical students. Students' engagement was evaluated by calculating number of engaged students in Kahoot! versus number of attended students in each lab. Students' satisfaction was evaluated according to students' feedback collected on Kahoot! platform and by an online questionnaire applied on Google Forms which included 5 items that were measured on a 5-point Likert scale, with 1 indicating strongly disagree and 5 indicating strongly agree, with overall satisfaction ranging between 5 (least satisfaction) and 25 (maximum satisfaction). YouTube videos were done to demonstrate and spread the idea of using Kahoot! platform in education particularly in the COVID-19 pandemic.

RESULTS

Kahoot! was successfully applied in Histology and Cell Biology lab sessions. Students' engagement for Kahoot! game-based formative assessments were 100% in most lab sessions. The mean overall students' fun assessment score for Kahoot! was 4.65 out of 5. Most students recommended the use of Kahoot! game-based formative assessments. The mean overall Kahoot! questionnaire satisfaction score was 24.25 (ranging between agree and strongly agree). YouTube videos were successfully published.

CONCLUSION

Kahoot! produces marked students' engagement and satisfaction in formative assessments enabling it to be applied live for any learning session either face to face or virtual for distance learning.

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.

Summative and Formative Style Anatomy Practical Examinations: Do They Have Impact on Students' Performance and Drive for Learning?

Anatomical knowledge is commonly assessed by practical examinations that are often administered in summative format. The format of anatomy practical examination was changed at the Lee Kong Chian School of Medicine in Singapore from summative (graded; must pass) to formative (ungraded; no pass/fail) in academic year (AY) 2017-2018. Both assessment formats were undertaken online, but the formative mode used a team-based learning activity comprising individual and team assessments. This gave an unique opportunity to investigate: (1) the impact of two different online assessment formats on student performance in practical examination; (2) the impact of new formative practical examination on students' performance in summative examinations; and (3) students' opinions of these two practical examination formats. The class of 2021 perceptions was obtained as they experienced both formats. A retrospective cohort study was also conducted to analyze the Year 2 students' performance in anatomy practical and year-end summative examinations of cohorts AY 2015-2016, AY 2016-2017 (summative format), and AY 2017-2018 (formative format). There were no significant differences in students' performance between two practical examination formats. The cohort who experienced the formative format, performed significantly better in summative examinations (mean ± SD: 82.32 ± 10.22%) compared with the cohort who experienced the summative format (73.77 ± 11.09%) (P < 0.001). Students highlighted positive features of the formative practical examination, including team reinforcement of learning, instant feedback, and enhanced learning. These findings indicate that students continue to study for anatomy practical examination without the need for external drivers. The team-based learning style practical examination enhances students' performance in summative examinations.