education
6 Jun 2008
Owning the Questions
How medical students at the University of Queensland are writing their own exams
According to documents made available to medical students within the School of Medicine at the University of Queensland this semester, students will be allowed to set a certain portion of their own questions during the examinations for the second half of the year.
A study is being done into the stress levels of medical students and how they perform when confronted with various forms of assessment. The news is curiously available for public consumption at the School of Medicine website, an indication of that department's sheer naiveté or ignorance. This voodoo exam-setting method is described in the project titled Enhancing Ownership of Assessment: Medical Students Generating Questions for their own Final Examination.
The aims of this grant (a UQ Teaching and Learning Strategic Grant) are to "improve students' problem-solving and comprehension-monitoring abilities as well as reduce their anxiety about assessment". To further this aim, students will contribute to "a bank of potential examination questions which will be available for revision and formative assessment in the weeks leading up to the final examination". This "bank" will contribute some 25 per cent of the final examination questions for students in both first and second year.
This, in a system where knowledge is ownership and the proletarian owners of it are the students. Some sense of this rationale is gathered in a lecture given to the students were by Tracey Papinczak, Senior Evaluation Officer within the School of Medicine in late April. She is one of those named on this particular grant. Self-regulation in education is discussed, along with various learning taxonomies. Self-direction or self-regulation (are students neo-liberal agents?) allows "students to identify how well they are covering the most important aspects of the subject material". To aid this, "exemplar" answers will be provided.
Would patients like their prospective doctors to set their own questions, with answers fully available prior to examination? Examinations, notably rigorous ones, are supposedly set by the wise, the learned, the educated. Ownership of knowledge is impossible to assume if you don't have it. Pupils and teachers should ideally engage in a dialectic of learning and disputation. But the medical school at the University of Queensland, demonstrating long strides of innovation befitting a Universitas 21 member, prefers a different approach.
The School of Medicine might argue this: there is a "quality control" mechanism in place; students are not being given an arbitrary hand in setting questions. The questions are screened. To refer back to Papinczak's lecture, "Poor quality ones will be returned to the group for a second try (weeks 28-29)". Appropriate questions will be uploaded to a central examination database available to all students. Patients are bound to feel reassured.
Students will finally be given a questionnaire prior to the examination to test their anxiety levels. The language resembles the most dire form of couch therapy: "Often I lie awake worrying about work that I think I won't be able to do". Answer options on the form range from "strongly disagree" to "strongly agree". Other questions: "I seem to panic if I get behind my work"; "I often feel anxious about whether I'll ever be able to cope with the workload". Anxiety is then "rated" on a 1 to 10 scale.
A few guesses can be made about the prospective findings. The figures may well show that students who set 25 per cent of their questions, with answers in advance, readily available on the net, will suffer less stress than those who don't. How wonderful it is to conduct research on a project when the answers are already certain.
This delusional nonsense is patterned on the self-directed programs that have gradually moved into medical school syllabi over the years. Students are no longer the taught - they will do the teaching and conduct the instruction. Modern medical students are there to be pampered and promoted. Let's just get them to mark their own questions in future as well, shall we?
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I’m afraid your entire self-indulgent rant smarts of ignorance; clearly Medicine is a field of which you have little understanding. If medical students are allowed to contribute a number of questions to a central question bank, from which exam questions can be drawn for both revision and formative assessment purposes, this probably will have the effect of reducing anxiety somewhat. But you’re missing the point. The sheer volume of knowledge to be learnt in a Medical degree means that comprehensive assessment is very difficult, therefore assessment comprises testing a core of vital knowledge, as well as an array of other questions, sufficiently varied, to test the breadth of knowledge. The purpose of examination is to test the knowledge of a candidate, and ensure it is sufficient to proceed to the next stage of learning. If the questions are screened for suitability, as they will be, I fail to see your problem with the concept. If a question is testing a key concept, and the student understands and gets the correct answer, does it really matter how the student gained that knowledge, or who wrote the question? Medicine is a field that continues to evolve, sometimes very rapidly, and therefore practitioners must commit themselves to lifelong learning. This of course, is mostly self-directed, and not examined by a third party, so is it not wise to get medical students into the practice of critical self-appraisal, and self-regulation, at an early stage whilst they are still being ‘moulded’, so to speak?
Now, back to your ignorance, the line about ‘modern medical students’ being ‘pampered and promoted’ is telling. Modern medical students, in the current educational climate of DIY medicine, are under more stress than ever before, as the onus is not only on them to learn the material, but also to gauge what exactly to learn, and how much depth to go into. If you think that that’s easy, maybe you should give it a go. Believe me, it ain’t no history PhD.
All the best.
mjp, well said!
Now, as a matter of common courtesy, why don’t you round off your contribution by providing us all with a name?
George Vickers
The previous poster made some excellent points when responding to this article, but the author may choose to discredit the points made due to anger with which they were presented. All anger aside, the main focus of the article seems to be that the students contribution of 25% of the exam material makes medical school easier. The author argues that moving in this direction is spawning a new generation of doctors that are "pampered and promoted". As a current student, I can tell you that this won’t change anything for me. If anything, this will add an additional 10 hours of study to the hundreds of hours that I and my fellow students do. That figure may seem exaggerated but I assure readers that it is not!
One thing that may have been overlooked by the author is that the students of the UQ medical program (along with all other medical programs) have been selected due to their academic excellence. They are a group of perfectionists that could have done anything with their lives but have chosen to help others. Upon acceptance, the students become colleagues in the medical profession. I see the generation of questions by the students as an exercise in self-regulation. Making and distributing questions is an opportunity to identify important concepts/information and ensure that all students are exposed to those concepts/information.
To have an informed opinion on this topic certain facts must be recognized. Medical students are comparable to graduate students, not undergraduates, and as such should be considered responsible/capable of directing their own education. As a collection of perfectionists, we would work tirelessly even if 99% of the exam was provided to us, because that extra one percent could save a life some day! The provision of 25% of the exam ensures that every student will be exposed to concepts/information that the students and medical school consider most important for good doctors to know; therefore adding a bit of direction to the testing process which involves an unimaginably large body of information. Also, no one has ever passed an exam with 25%. Finally, the author has displayed that they don’t understand what it means to be a doctor. It is worth exploring different methods of testing if it helps produce better doctors. We are not working for high marks and fancy diplomas we’re working to save lives.
I will concur with mjp and canada83 , you need to experience the depth of complexity of medical study to understand that the ability to set an exam question is a great indicator of comprehension and also an indicator of the level of understanding within that group of students.
My partner is currently studying to upgrade her nursing qualification , those studies are now done at a medical degree level. The level of study goes far beyond a business degree where essentially knowledge by rote is what is necessary , in the sciences you keep reading and studying until you comprehend , if this takes you far beyond the knowledge that will be examined , well that is what it takes.
I’m afraid Binoy Kampmark reveals an alarming ignorance of modern educational and especially assessment practice. The old method of springing unknown questions on students in the stressful context of the final exam is simply bad practice; it is like shooting fish in muddy water. You only get an approximate idea of how many fish are really there, or to drop the simile, of what the student really knows. Allowing students to set some of the final questions is really quite conservative, although if the questions they set are open-ended questions requiring students to reflect on their learning experience in relation to what they are supposed to learn, such questions can be extremely valuable. If we want to know what students know, and the extent to which they can use their knowledge (which is the real point), the final exam format in general is not aligned to what we really want students to learn, and is therefore I’m afraid near to useless. It is more of a limited kind of intelligence test rather than of how good a practitioner the student will be. Far more authentic are assessments that allow students to tell us what they have learned, not us second-guessing their learning. Portfolios, simulations, practica, case-studies, and so on are far more effective assessment methods. If Binoy wants to catch up on this, see Biggs, J. and Tang,C., Teaching for Quality Learning at University (McGraw Hill Educational,2007).
I completely fail to understand why the reaction to this article has been quite so negative. MJP, in particular - "it ain’t no history PhD". I wonder how you would know that? You write in a manner so uninformed that I wonder if you have even evolved opposable thumbs.
This article raises an important issue which the above comments have seriously overlooked - medical students are becoming pampered and pandered to by teaching courses throughout their training. The rather unpleasant realities of ‘pressure’ and ‘stress’ are being ineffectually combated by limp-wristed university guidelines imposed by vice chancellors terrified about soaring drop-out rates. This means that by the time trainee doctors have to practice for real, they are hopelessly underprepared mentally (and often academically) for what they have to face. Stress, I’m afraid, is a part of the job and learning to cope with it should be a part of the course.
Allowing students to set their own exam questions is clearly ridiculous in any field. I speak as an experienced university teacher myself. I agree that having the students set their own work throughout the term has its uses: I will often give students a bibliography and send them away for a week to come up with their own essay topic. This breeds creativity, depth of thought and tends to work well. Having a student make up a topic for a mid-term tutorial, though, is an altogether different prospect than having them make up an exam question. The idea of the end of term exam is that the student is highly alert, on his or her toes to the extent that he or she can respond to almost anything unexpected or otherwise. Having some clear idea of exactly what might come up defeats that purpose.
This seemed like a fine, well-written article to me, which has been undeservingly pilloried.
The_Professor:
You seem to be displaying some of the qualities you’re critisising in other contributors: You assert that medical students are ‘pampered’, doctors are hopelessly underprepared and that med course drop out rates are soaring. Where on earth did you get this information? Can you provide me a reference please? As an experienced university teacher, I am sure you understand that such broad sweeping inflammatory statements, made without reference, are entirely unacceptable.
Your comment (like the article itself) comes across to the reader as an uniformed diatribe, full of emotive language that seems to simply be having ‘a go’ at another profession. IMHO (and to read between the lines), it seems to be a member of another field having a go at a more ‘established’ or ‘higher regarded’ area of study.
And yes i am a medical student, who will be soon helping to contribute to the bank of formative assessment, SOME of which will appear on the end of year exam. I’m looking forward to doing so, I think that it will be an effective addition to our study methods. And to assist my collegues and I to retain and comprehend issues that will make us effective Doctors. (And don’t worry, there is still PLENTY of stress to endure: both for this exam and after, where I have 2 more years of rather stressful clinical training).
Who knows? We may encounter each other one day, The_Professor (or you Binoy): you as a patient and me as your doctor. As your knowledgable, prepared and competant doctor, treating you with skill, as a result of the education I received here at the University of Queensland.