By: Dr. Sue Murphy B.H.Sc (PT), M.Ed (Biography & Disclosures), No Disclosures.
What I did before:
One of the topics examined in my initial “professionalism” course are the bylaws and Standards of Practice of the licensing body. Bearing in mind that the end goal is that students should be able to apply these standards to practice, not just memorise them, the multiple choice question (MCQ) exam format I have used contained a typical practice scenario with a variety of possible options for action, with instructions for the student to select the “best” option. In order to succeed in this exam, students do, however, need to have a working knowledge of the by-law and practice standards content at their fingertips – which, given that there are 13 standards of practice in addition to 60 sections of bylaws, is a fairly big “ask”! Students complained that “memorising” the standards was a waste of time, and the old MCQ system did not allow students with poorer memories to demonstrate their competence in applying these standards to clinical scenarios.
What changed my teaching practice:
“Authentic Assessment” can be defined as “a form of assessment in which students are asked to perform real-world tasks that demonstrate meaningful application of essential knowledge and skills” (Jon Mueller, http://jfmueller.faculty.noctrl.edu/toolbox/whatisit.htm) Although I felt that the MCQ exam format I was using “demonstrated meaningful application of essential knowledge”, what it was not addressing was the “real world task”. Which health care professional, when looking for an answer to a problem requiring knowledge of their professional standards, would not go to the website or binder to remind themselves of the standard details and to find guidance?
Open book exams are not something traditionally considered in medical and health professional education. Yet, by allowing students to access information during an exam that would be readily available to them in “real world” situations, we can potentially make assessment more authentic, and give much needed practice on being able to find relevant information in a time-sensitive way – a crucial skill for today’s health-care professional.
What I do now:
The MCQ exam format has largely stayed the same (i.e. scenarios followed by a range of response options). However, students are permitted to consult copies of the professional standards and bylaws if they wish to do so. As we do not have access to software which only enables access to specific websites, students need to access paper copies of these documents. Which documents are allowed to be brought into the exam and which are not are explained in detail prior to the exam; students are aware that random spot checks of documentation brought into the exam room will occur, and have so far resulted in little deviation from what is allowed. Students were warned in advance that there would be a tight time frame for the exam, so they would need to have enough familiarity with the material in order to quickly find the detail they might need.
Reaction from students has been overwhelmingly positive. Students commented that knowing it was an open book exam was an incentive to know the material in more depth, and that practicing where to find information quickly facilitated deeper learning of the content. Students also felt they focused more on actual learning of the material and when to use it, as opposed to simple memorisation. Instructors felt that students knew the material in more depth, and were more familiar with the breadth of information in the standards.
How your experience is relevant to teachers in the Faculty of Medicine:
I encourage others to consider whether an open book exam format would be beneficial and provide more authentic assessment for part of their curriculum. While this approach may not be suited for all situations (such as assessment of skills required for emergent clinical situations), it may be a good fit for those areas of the curriculum which address topics such as ethics or professionalism, where consulting a reference may be a “real world” response.
Further Reading (Reference articles and add resources here):
Open book assessment in medical school: Neel Sharma, Medical Teacher, Vol. 37, No. 2: 201-202. Free full text.
Influence of open and closed-book tests on medical students’ learning approaches: M Heijne-Penninga, JBM Kuks, WHA Hofman, J Cohen-Schotanus, Med Educ 2008; 42:967–74. Free full text.
Open book tests: assessment of academic learning in clerkships: India L Broyles, Peggy R Cyr, Neil Korsen, Medical Teacher, 2005: 27(5):456-62. Free full text.
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