How can CAA support the acquisition of medical knowledge in an integrated medical curriculum?

1. How can CAA support the acquisition of medical knowledge in an integrated medical curriculum? Chris Ricketts Sally Wilks Adrian Freeman

2. Outline • Curriculum and learning • Assessment of learning (progress testing) • Assessment for learning (for debate)

3. Curriculum and learning (1) • Not discipline based (anatomy, physiology, etc) • Not specialty based (paediatrics, surgery, radiology, etc ) • Integrated curriculum based on ‘case presentation’

4. Curriculum and learning (2) • Nineteen 2-week cases (normal and abnormal) over 2 years • Problem based learning (PBL) is the key • Supported by activities in a Life Science Resource Centre, talks by plenary speakers, address issues in basic science, social and human science, ethics, and public health

5. Assessment of learning (Applied Medical Knowledge) • a 125-item test administered 4 times per academic year to the whole School. • level of the test is set at that expected of a recent graduate.

6. 80 ‘80 ‘81 ‘82 ‘83 ‘84 ‘85 ‘86 ‘87 ‘88 70 R 60 6 5 50 4 40 30 20 10 0 2 4 6 8 Progress Test Results (from Maastricht) %Correct ‘78 ‘79 3 2 1 Tests

7. Assessment of learning (Applied Medical Knowledge) • delivered via a printed paper and answers entered on an OMR sheet for marking. • feedback to students is via a list of key ‘learning points’, one for each question in the test. • the questions are not returned to the students as the question bank is shared with an international consortium of medical schools and must be secure.

8. A 74 year old woman is diagnosed as suffering from Atrial Fibrillation, confirmed on ECG. She is well apart from mild hypertension for which she takes regular Atenolol and Bendrofluazide. After discussion with the patient you decide to start treatment with Warfarin anticoagulant. What regular blood investigations will she require to monitor her medication? A. Vitamin K estimations B. International Normalised Ratio C. Thyroid function tests D. Factor IX levels E. Platelet count F. Don’t know

9. Assessment FOR learning • Progress testing is problematic for students in years 1 and 2. • Does not clearly reflect what they have learned. • How do we encourage and reassure students? • While keeping the best features of progress testing. • And not over-assessing!

10. Assessment FOR learning – a possible approach • Develop a formative question bank (use collaboration questions). • Provide answer-specific feedback (very time-consuming – use students) • Use formative on-line testing (CAA). • 70% of students said they would use computer-aided self-assessment

11. Assessment FOR learning – some possible problems • What level should we use? • Should we limit subject content? • How should we structure each ‘test’?

12. Assessment FOR learning – what educational features do we want to encourage? • Deep learning • No cramming • Testing breadth

13. Assessment FOR learning – what do student want? • To know if they’ve ‘passed’ • To have a ‘fair’ method of assessment

14. Assessment FOR learning – a compromise? • ‘Case unit’ based assessment • All aspects of the case

15. Questions and suggestions???