Assessment

Prof. H Kabir Chowdhury

Assessment is an immensity important activity that all medical teachers are intimately involved with. The medical teachers competency in student assessment include understanding the basic principles of assessment & recognizing the advantages and disadvantage of various assessment tools.

What to assess

  1. Knowledge (Cognitive)
  2. Skill (Psychomotor)
  3. Attitude (affective)

Assessment types

  1. Formative
  2. Summative
  1. Formative assessment starts soon offer Induction of the educational data from assessments, used to further improvement of the student’s learning. Also it is used to correct the program.

B.Summative Assessment

  1. Determine whether the student has achieved a certain standard.
  2. Summative assessment is outcome focused.

Assessment instruments:

  1. Essay Questions
  2. Objective questions
  3. Oral examinations
  4. OSCE
  5. Standardized and simulated patients
  6. Real patients
  7. Observation
  8. Video and audio recording
  9. Logbook
  10. Self assessment
  11. Portfolio

To question well is to teach well. In skillful use of questions more than anything else, lay the fine art of teaching.

Step of questions:

  1. Factual questions
  2. Clarificationquestions
  3. Extension questions
  4. Justifying questions
  5. Questions about questions
  6. Redirected questions

Dealing with student response

With the student fail to answer ask them

  1. Is the question clear to you
  2. Do you want me to rephrase the questions
  3. Which part the questions you did not understand
  4. Is it too difficult

With careful guiding it may be possible to elicit the correct response what then:

(i)Allow time

(ii)subsequent questions with clue to the answer

(iii)Reframe

What should not be done:

  1. Don’t interrupt
  2. Don’tprovide answer
  3. Don’t ask another question immediately
  4. Don’t provide your opinion
  5. Don’t criticize

Studies haveshown that even modest increase of wait time, the correctness improves.

Failure of response by a student is often lack of understanding the question.

So

  1. Phrase question clearly
  2. Ask question with specific intention
  3. Allow 10-15 sec. wait time
  4. Encourage student to respond even if wrong
  5. Probe students answer to clearly ideas, reasoning process
  6. Do not immediately assume that failure to answer due to ignorance
  7. Acknowledge correct answer
  8. Make conscious efforts to ask higher cognitive order questions

Oral examination

Lack of reliability and consistency in scoring

This may originate from examiner, examinee or the format

Serious flared by extend appearance or the attnbulis

Lack of standardization & reproducibility

Lack of transparency

Fear of manipulation & favoritism

High manpower utilization

Undue anxiety among the students

Good sides of oral examination are:

Allows to assess

Rezoning and deductive process

Problem solving

Capability to defend decisions

Face to faceinteraction

Flexibility etc.

But practice of these features during examination requires a high level of training and motivation of the examiners.

Oral examination is a useful tool for formative assessment but not for summative assessment.

It can be improved by structuring the exam which to requires extensive utilization of time, manpower,motivation and training.

Oral Examination may be improved as regards validity & reliability by

a)Problem solving & critical reasoning, b) standard predetermined questions,

c) Predetermine model answer, d) Pre-agreed scale, e) Independent scoring,

f) Longer examination

What can be done:

  1. Present situation allows many students to qualify without achieving the standard.
  2. In any country there could be medical institutions of various standards. Standard of a particular institute reflects the philosophy, dedication and pioneeringrole of the faculties and administration to decide where to go and what to achieve.
  3. Considering that the present system will not change in the near future, we can probably act to work on theformative part of the program.
  4. It we divide to do that we can make a change in the knowledge, skill and attitude of our students by restructuringthe program, understanding the students,improving the faculty competence and at the end improving learning by the students.
  5. Assessments are the integral part of the curriculum which dictates present day students how to act.

Feedback

There is a difference between praise, criticisms and feedback.

When a student escorts an elderly lady gently in a clinic if you say “You did a good job” is praise but if you say “you have volunteered to escort the lady. This will put the lady as case & this builds a good report between doctor & patient” is a feedback.

A good feedback is “You have obtained a good history of this patient with chest pain, but I noticed that you did not explore the cardiovascular risk factors such as smoking dietary habits and life Style.” Avoid: you are weak in history lacking

So

  1. Feedback is an educationally sound way of communicating teacher’s observation to the students.
  2. Feedback differs from criticism and parse.
  3. The focus is to change not judgment.

Ref.

1. Basics in medical education. By Amin & Hoon Eng

2. A practical Guide for medical teachers. By Dent & Harden