MÓDULO DE INDICADORES DE RESULTADOS a. Información de referencia

In the MBBCh undergraduate programme students are assessed in various ways.

Formative and summative assessments are presented in the form of written tests, practical exams, assignments and portfolios. A variety of written test and examination formats are applied including multiple choice questions and short answer questions. Assessments are spread throughout the year at varying intervals depending on the year of study. There were variations in the way students experienced assessments. Sometimes positive and negative conceptions were aired at the same time as in the statement below which shows that in the block system, integrated assessments were appreciated.

…second year was very separate… like, you wouldn’t find Physiology questions in an Anatomy paper, it would be strictly Anatomy and Physiology would be strictly Physiology and Molecular Medicine and so on and so on… whereas now when we write it’s all together. You have to study everything...the papers in SAQs² definitely are integrating with the case given the whole case study and from that you must know your way and work it out. You are supposed to know a little bit of Pharmacology and Pathology, a little bit of everything on the case so you are definitely integrating but unfortunately as a student you want to pass your exams and sometimes you don't always integrate everything together or study for it… [Student 7, MBBCh 4]

From Student 7’s conceptions, some of the exams are integrated although the student’s focus is on studying for passing. There was a variation of perceptions from the teachers’ points of view. Several teachers’ perceptions of the block approach is that it does not promote integration of learning. In addition, the students are

2 Short answer questions

perceived to be attuned to the block structure so much that they compartmentalise their learning and expect compartmentalised examinations:

…the discipline-based knowledge is largely assessed in multiple choice questions, so that at the end of every block, the students have a Multiple Choice Question exam and each discipline, like Anatomy, Physiology, Microbiology and Pathology… will set a certain number of questions on purely what they taught in that block…so there isn’t very much sort of integration if you like… [Teacher 1]

But this layering of information I think is… it’s very difficult to instill in them, they sort of feel “I have done this, when is the exam or test, after I have done it, I can wipe it out I don’t even have to remember…” part of the problem is this block-by-block learning, but it was a Physics thing and now I am in Chemistry and in fact they complain if you try to set a question that looks like it’s using Chemistry principles uh they’ll say “Oh, but this is Physics, it’s not Chemistry”… [Teacher 9].

A variation on students’ experiences is that assessments played a role in preventing integration of learning, citing lack of congruence between what is taught and expectations in assessments, and lack of standardisation of approaches:

… Multiple Choice Questions… I think they just put less of different subjects and then they just put the questions together. I don’t think that they really integrate the questions themselves…they just ask you; give the features that explain this diagnosis or something and … that’s all you have to write, you don’t have to think more than that... [Student 17, MBBCh 3]

Some students explained that sometimes in what is called an “integrated” test or examination the questions for each discipline are separate or require discipline-specific answers.

You see another problem which I mentioned was that we study only for exams.

Why we study only for exams especially your final year and in your fifth year because every six weeks you have a rotation. The six weeks is pass, it’s like “do or die”...You wouldn’t worry about the rest. Why? Because it’s not for the exam so that’s a downfall. So now when you come to the real world you know only a handful of stuff that’s what came in exams... [Student 6, MBBCh 6]

A teacher responded to the question on how the students were being assessed in respect to integration and the response was:

l think a lot of the assessment is pseudo integrated. You got a case but you got very distinct demands within the case... So l think a lot of our cases, we’re trying

to make this kind of fancy integration but, in fact, the students haven’t got that yet... [Teacher 5]

The experience of Teacher 6 is that the block system discourages integration if assessments follow the same block structure:

…if you put an integrated approach to a patient, they have to go and learn an integrated approach but if you put a block assessment method only… they are only going to pick up and focus on medicine. They are not going to bother about the Gynae history of a patient who has heart problems or how many times she’s been pregnant. So I think that that’s a fundamental flaw… it comes back to GEMP 3 and 4 (MBBCh 5 and 6), we’re just too compartmentalised and students have picked up on it; ‘why should we worry about integrated learning or an integrated approach to a patient… that’s not what we’re getting tested on. Our objective is to examine the chest or the lung’, that’s it, nothing else not even the rest of the body. And now we want these students to come out and say that they have had a nice integrated curriculum but they don’t. I think at the end of the day, the assessment that we set will do what we need to do… [Teacher 6]

In Student 6’s experience the concern is the frequency of assessments which prevented studying other than for passing. Sometimes students focused on spotting and memorising what they thought would come in the examinations to the detriment of integration. As discussed in the earlier sections of this chapter studying plays a pivotal role in enabling students see links in subjects.

Due to the pressure of work, students try to obtain clues about exams from the teachers, thus seeking guidance about the core to focus on when there is content overload. They then focus their attention on what is likely to come in the examination, not necessarily the core content that is necessary for integration of learning. However, sometimes students experienced a mismatch between the core that was emphasised and the focus of the examination as in the next quote:

And I think that the way assessments are run is that you can be given information in class and in lectures, and these people tell you this is important, this important, this is important. You go to the exam they ask you... and you sort of like; “you guys keep saying that this is how I should learn and the way I should take everything but the way you ask is such that by the time I get to this and that you ask me something which is very far away from the core principles of how I’m supposed to be thinking”... it becomes difficult for you because now you are forced to learn the extremes… [Student 4, MBBCh 4]

It is a widely researched conception that assessment drives learning (Wood, 2009;

Wormald et al., 2009). Since students’ experience is that they learn for tests and exams, they will, therefore, not spend much effort on those aspects of the programme that are not assessed:

...the only way you pass is by passing exams and tests... sometimes you just do enough to be able to pass, and you might not integrate things, you might not take this and that whatever, you might say “listen I am here for my exams so I’m going to study, I’m not going to bring this into it”... and so, like I think it’s too hard you know as a student… [Student 1, MBBCh 3]

Teachers were also aware of the fact that students study for assessments – since integration of learning is not assessed, students will not bother much.

Some students failed to see the relationship between assignments and integration.

The assignments…they don’t really help to integrate, but they help to reinforce the stuff that you learn…in my opinion… [Student 12, MBBCh 2]

I don’t think integration really plays a role in assessments … [Laughter] I don’t think they correlate… we are assessed on notes that we have been given on the subject. And the focus is on the subject. It doesn’t really matter what you are doing with the subject. It doesn’t really matter your prior knowledge. If you know these notes then you know that you can pass the exam. I don’t think they really impact on each other… [Student 14, MBBCh 2]

Students perceived value of a subject as judged by the weighting of marks is also a determining factor of the amount of effort put into studying that subject as evidenced below:

I think you “spot” a lot you know, I think as a student you, Uhm, already know what the lecturer said to you, so you only study that section and you eliminate the rest of the lecture...leave out the Pharmacology because I know the Pharmacology will be 10 % of the work or 5 % of the paper so I would rather lose that 5 % and focus on another section. So, I think... I think in exams and tests, you, Uhm, you more focused on specific things, than actually seeing the bigger picture of things… [Student 2, MBBCh 4]