TSR Med Students' Society Part III

Exams annoy me in some respect but better than assessed coursework

My preferred method would be total continuous assessment but that would be impossible

I think that progress testing with finals multiple times each year would definitely be beneficial in clinical years at all medical schools.

Back to assessment methods.

I think that progress testing with finals multiple times each year would definitely be beneficial in clinical years at all medical schools.

I would rather medical school did not become like sixth form where it was a constant run of exams that meant teaching was to the test rather than for the ultimate purpose of gaining knowledge.

I would rather medical school did not become like sixth form where it was a constant run of exams that meant teaching was to the test rather than for the ultimate purpose of gaining knowledge.

Quite the contrary.

Progress testing would eliminate that, testing beyond the level of the students current progress within the course would detract from cramming.

These tests would be independent from the curriculum. There can be no intensive pre test revision strategies to distract from the designed learning of the curriculum(1). This prevents a superficial test driven approach to study (2).

1. Newble DI, Jaeger K. The effect of assessments and examinations on the learning of medical students. Med Educ 1983; 17(3):165-171.

2. Blake JM, Norman GR, Keane DR, Mueller CB, Cunnington J, Didyk N. Introducing progress testing in McMaster University's problem-based medical curriculum: psychometric properties and effect on learning. Acad Med 1996; 71(9):1002-1007.

Dude, you did not just reference your own post...

Agreed but there has still got to be some sort of assessment to proove the teaching is allowing you to gain this knowledge. Correct me if i'm wrong but i'd feel a series of synoptic smaller exams/assessments would be more beneficial to ensuring knowledge is retained than one big lump exam, clinically and pre-clinically.

Agreed but there has still got to be some sort of assessment to proove the teaching is allowing you to gain this knowledge. Correct me if i'm wrong but i'd feel a series of synoptic smaller exams/assessments would be more beneficial to ensuring knowledge is retained than one big lump exam, clinically and pre-clinically.

I think there is a need to test, of course, but there's enough crammed into the medical degree as it is (sadly at the expense of being able to learn much in detail, in most curriculums), to make space for more frequent assessment. And there is a need to check that you know everything you should know - after all, your patient is not going to present with only the thing you learned most recently.

I guess my beef with any form of nationalised testing, whether that be progress testing or any other exam, is that regardless of whether you can teach to it or not, it will influence curriculum design, and it will always be inherently biased towards certain schools - is this not why there is as yet no agreed exam, because certain schools are pushing for in depth science and others are pushing for communication skills, etc, all at the greatest benefit to their own students?

True, but what material would you use for the clinical regular knowledge examinations?

However, using finals material for first years isn't shown to be very reliable.

That is the exact reason for the lack of a national exam. However what would be so wrong with in-house multiple exams at finals level? For students in clinical years?

Surely repeated testing of the final outcome expected would be beneficial?

I fail to see how repeated testing of the same material (which I presume the progress test to be, else how would it show progress over time?) shows anything except how many questions a student can memorise from previous papers? Surely repeated testing of finals material just massages the results? To my mind, testing should be appropriate to the level of teaching - I can't see the point in presenting students with questions that they haven't the expertise to answer. Else why not just replace finals with questions taken from the MRCP/S/GP and see how students perform? We have finals mocks in December and the real thing in June of fourth year, with an OSCE in fifth year, and to me that seems an appropriate amount of testing without continually eroding practical learning time. At clinical level, you're being tested every day on the wards, in a much more realistic setting than an exam hall - in real life you can't go "I'll think of the answer in a minute, I'll just leave that patient and come back to it later".

I fail to see how repeated testing of the same material (which I presume the progress test to be, else how would it show progress over time?) shows anything except how many questions a student can memorise from previous papers? Surely repeated testing of finals material just massages the results? To my mind, testing should be appropriate to the level of teaching - I can't see the point in presenting students with questions that they haven't the expertise to answer. Else why not just replace finals with questions taken from the MRCP/S/GP and see how students perform? We have finals mocks in December and the real thing in June of fourth year, with an OSCE in fifth year, and to me that seems an appropriate amount of testing without continually eroding practical learning time. At clinical level, you're being tested every day on the wards, in a much more realistic setting than an exam hall - in real life you can't go "I'll think of the answer in a minute, I'll just leave that patient and come back to it later".

I am not suggesting using the exact same material, I am suggesting the use of 80% of clinical medicine (the level needed for FY1s) with 20% Basic sciences material. This would be a vast array of different questions.

It would be far too hard to prepare for that kind of test. It realistically would not erode practical learning time as an exam would only be about 3 hours long and delivered every 8 weeks. It would in principle, sample at regular intervals from the complete domain of knowledge considered a requirement for medical students on completion of the undergraduate programme

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You're not addressing a lot of my points though. What is the point in testing students at a level above that required at that stage of their training? Why is continual assessment even needed? Surely practical assessment of knowledge on a daily basis (i.e. ward round questions, 'does this student know what they're talking about re this patient's diagnosis, management, etc?' and so on) is far more appropriate than exams every 8 weeks? I'd be fairly fed up if I had to sit a 3hr exam every 8 weeks! Exam stress is quite sufficient without making it any more frequent!

Anastomosis (with some angiogenesis)

Very much, just paper-based rather than web-based.

Whilst we're on the topic of exams, what do people think of not disclosing marks and scores and simply having a pass or fail system? Obviously marks and the like are collected for foundation post ranking purposes and analysing the examination system etc., but they are not published for students. The students are just told if they passed or failed (or any borderline-type marks that some schools give out).

I feel like it might reduce some of the petty competition that seems rife amongst medical students and facilitate students learning from each other.

That's how it's being done at my uni now for year 1s and 2s. Our year was the last cohort to go through the grade system for exams (A-distinction, B-merit etc etc E-fail). I agree that it did make people super competitive, but i wouldn't say it's a bad thing. Those who worked harder than others were suitably rewarded with a higher grade, so its only fair.

In principle I agree with you, but I've experienced idiotic things like people being reluctant to disclose a resource they got a certain piece of information from or not contributing in PBL so as to avoid disseminating their work.