November 2020

Who knows best how to assess? How to assess? Perceptions and preferences of undergraduate medical students concerning traditional assessment methods. Holzinger A, Lettner S, Steiner-Hofbauer V, Capan Melser M. BMC Medical Education. 2020;20(1):1-7. Reviewed by: Zachary Blatman and Angela Punnett

What was the study question? What are medical students’ perceptions of and preferences for traditional assessment methods in undergraduate medical education? How was the study done? 459 second year undergraduate medical students at the Medical University of Vienna completed a questionnaire exploring their preferences regarding traditional assessment methods as well as their perceptions of assessments’ association with long-term knowledge acquisition, objectivity, difficulty, duration, and content. Ordinal scales were utilized to measure students’ level of agreement from “strongly disagree” to “strongly agree”. Students were also asked to indicate what percentage breakdown of assessment methods they would prefer if they were allowed to decide. What were the results? Multiple choice questions (MCQs) were the preferred assessment method over oral examinations (OEs) and short answer questions (SAQs), and were also considered the most objective. While medical students perceived OEs as the most useful for long-term learning, OEs were considered the least objective evaluation format. Female students demonstrated a significantly increased preference for OEs than male students. There was no significant difference between MCQs, SAQs, and OEs in perceived difficulty, duration, and content of assessment. If given the choice, students would prefer an assessment breakdown of 41.8% MCQs, 24.0% OEs, 9.5% SAQs, and 24.7% other examinations such as objective structured clinical examinations and open-ended questions. What are the implications? Most medical students prefer MCQs because they are perceived as more objective and easier to study for. In contrast, there was no significant association between students' perceptions of long-term knowledge retention from an assessment and their evaluation method preferences. The authors argue that ensuring student satisfaction with curriculum assessment methods through assessment of preferences and perceptions promotes a healthy learning environment and encourages students’ motivation to both study and ultimately apply their medical knowledge in clinical practice. Editor’s note: This study is interesting in that it describes a clear discrepancy between students’ preferred assessment methods (MCQs), and what students identify as better for long-term knowledge retention (oral examinations). It should be noted that these were second year students so presumably had limited clinical experiences. The authors describe that MCQs are more in keeping with a surface approach to learning, and students agree that there is less long-term learning with this format. The question then becomes whether students’ preferences should even be considered in the distribution of types of assessments. When given a choice of preference for dinner, a child may say 3 Kit Kats, 2 boxes of Smarties and 1 Twix. Does that mean they should get to choose? (KFo) Reassuring news about distance learning Synchronous Distance Education vs. Traditional Education for Health Science Students: A Systematic Review and Meta-Analysis. He L, Yang N, Xu L, Ping F, Li W, Sun Q, Li Y, Zhu H, Zhang H. Med Educ. 2020. ePub ahead of print. What was the study question? How effective is synchronous distance education (SDE) compared to traditional classroom-based education for health sciences students and how satisfied are learners with each format? How was this study done? Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), the authors searched 9 different databases. Studies were included if they 1) were conducted among health sciences students; 2) used synchronous distance education in the experimental group; 3) involved traditional education as the control group; 4) included quantitative outcomes (knowledge and/or skills) and subjective course evaluations; and 5) were randomized-control trials. What were the results? Seven articles met inclusion criteria out of 1,686 potential studies. Analyzing data from these studies based on knowledge acquisition or gains based on pre-/post-tests did not identify significant differences between online learning and traditional learning. Additionally, three studies assessing skills were not significantly different based on educational modality. Overall satisfaction was higher among learners in the SDE groups over traditional classroom teaching. What are the implications? COVID-19 has forced medical educators to teach online. The results of this meta-analysis indicate that the quality of education is not hampered by online education. A serious limitation of this study is limiting the analysis to only randomized-control studies. Although they evaluated their work for potential bias, the lack of studies assessing skills (only 1 reported the actual skill evaluated) cannot be discounted. Some clinical skills can potentially be taught and evaluated remotely….but not all can. This meta-analysis makes the case for delivering didactic material online, especially given students’ higher satisfaction with that method of teaching. Editor’s note: The results of this study are somewhat reassuring. However, it is important to note that the participants in many of the trials were volunteers, and SDE may have been only one component of their medical education I wonder whether students would be as satisfied if they were surveyed now. (JG)

Helping students get ready for clerkships Closing the Gap Between Preclinical and Clinical Training: Impact of a Transition-to-Clerkship Course on Medical Students’ Clerkship Performance. Ryan MS, Feldman M, Bodamer, C, Browning J, Brock E, Grossman C. 2020. Academic Medicine; 2020 Vol 95 (2) 221-225, Reviewed by Nicole Meyers and Suzanne Friedman What was the study question? Given that medical students usually perform better on clinical rotations that occur later in their training, can a transition-to-clerkship courses (TTCCs) better prepare students for their clinical clerkships? Methods A number of stakeholders at Virginia Commonwealth University School of Medicine (VCU-SOM) contributed to the development of a TTCC that included panel discussions, skills sessions, and case-based workshops during the 2014-2015 academic year. A ward simulation was then added to the course in the 2015-2016 academic year. Students’ perspectives on their preparedness were measured using a survey right after the simulation and then 3 weeks after the start of their first clerkship. Performance was assessed by comparing clinical evaluations for students from (1) Group who received the standard curriculum in 2013-2014 (standard), (2) Group who received initial version of TTCC in 2014-2015 (TTCC), and (3) Group who received second version of TTCC with addition of ward simulation (TTCC + simulation). Results Students reported improved confidence after the ward simulation and rated the interactive activities such as the case-based workshops the highest. There was a significant difference in overall clinical performance when comparing students in the TTCC + simulation group vs. the standard group. When comparing the TTCC group to the standard and TTCC + simulation groups, there were only significant performance differences seen for certain clerkships. Implications: This study demonstrates the importance of integrating certain elements, e.g. simulations, in developing effective TTCCs. Institutions should consider incorporating features of TTCCs earlier on and more continuously throughout the preclinical phases of medical school curricula, as opposed to only during the dedicated TTCC time. This may include patient-simulated experiences, boot camps, or other clinical-focused courses to prepare students for the next stage of training. It is essential for institutions to critically evaluate their own TTCCs to guide universal best practices and ensure a seamless transition from the preclinical to clinical phases of medical school. Editor’s note: Some students seem born ready to tackle the demands of their early clinical rotations while for some the learning curve is much steeper. Tasks such as oral case presentations and documentation can and should be taught and practiced before clinical rotations, ideally in a longitudinal fashion. Supplementing that education with a dedicated TTCC can enhance students’ preparedness for their clinical rotations at their outset. (RR) Binge, forget, ….remember? Activating prior knowledge using multiple-choice question distractors. Schimmelfing LC, Persky AM. Medical Education 2020 54(10): 925-931. Recorded Review by Barbara Dietrick, Amit Pahwa and Jon Gold.