by Kellen Riley, Doctor of
Pharmacy Candidate, University of Maryland School of Pharmacy
As
pharmacy students advance through their didactic curriculum, a fundamental
switch in learning occurs. While the first few years of classes consist largely
of rote memorization - of brand-generic pairings, therapeutic classes, and
anatomy – sometime during the second or third year, students are expected to
begin synthesizing the knowledge previously gained to arrive at the “most appropriate”
clinical decision. Aptly so, as these students are preparing themselves for
careers as pharmacists in a world where most answers are not black and white.
When
students begin to migrate away from memorizing facts toward synthesizing
clinical decisions, they realize that the multiple-choice exam becomes less and
less appropriate as an assessment tool. This phenomenon becomes most apparent to
me when my classmates and I are engaged in case-based discussions in a course that
uses multiple choice exams:
Imagine that you are the student. You value the discussion
taking place and know that it is strengthening your understanding of the
material. But in the back of your mind, unavoidably looming, is the exam. You
know that in a few short weeks, you will sit for a test in which there is
literally only one best answer and you will be forced to sift through all the information
you can recall about this topic and choose just one. Even though you understand
that there isn’t one right answer, you also want to be able to do well on that
test. Finally, one student raises his or her hand to ask the question that is
on every student’s mind: “OK, but what is the right answer?”
Now imagine that you are the professor leading the discussion.
You have just spent the past five minutes having a lively and engaged
discussion. Students are furiously
typing notes and asking intelligent questions. After all the discourse in which
you have obviously stated that this particular scenario is not quite clear-cut,
to your dismay, a student raises his or her hand and asks, “OK, but what is the
right answer?”
This
question can be posed many different ways (“So, if we were to get this question
on the exam…” or “If we had to pick only one answer…”), but in each case the
theme is the same: in courses where multiple-choice examinations represent the
majority of a student’s grade, the students’ priority is ensuring maximal
success on these exams, even if the methods of achieving that goal seem to oppose the “critical thinking” atmosphere created by the instructor.
I know
from personal experience that my classmates and I do not perform as well on
multiple choice exams in case-based courses. Despite the desires of the professor, many
students prioritize exam preparedness over learning objectives and lively
discourse, if they believe their grades will suffer. Some researchers have
examined the effect of multiple choice exams on the learning environment. They found not only that students’ perception
of their learning was strongly correlated with the type of examinations used
but also found that multiple choice exams can hinder critical thinking skills.1,2 Some
argue that multiple choice exams are not inherently bad assessment techniques, but
that the most important consideration when evaluating students’ learning is
that there is an alignment between the way the material is presented and the
way it is assessed.
Thomas
Reeves, a professor in the Department of Educational Psychology and
Instructional Technology at The University of Georgia, examined the alignment
between eight critical factors (goals, content, instructional design, learner
tasks, instructor roles, student roles, technological affordances, and
assessment), and their effects the learning environment.3 According
to his research, the factor most often out of alignment was assessment, and he believes
the blame falls on the instructor:
“Simply put, instructors may have
lofty goals, share high-quality content and even utilise advanced instructional
designs, but most assessment strategies tend to focus on what is easy to
measure rather than what is important.”3
Reeves’
characterization of multiple choice exams might be a little unfair because
multiple choice exams may in fact be the only feasible method for instructors to
provide timely feedback to a large group of students. While every student wants
the assessment to be “completely fair,” the second most predictable desire of
students regarding exams is that they want to receive feedback “like, yesterday.”
While good
grades are nice, students place importance on examinations that are an accurate
reflection of their knowledge and skill.
In courses that require critical thinking and synthesis, multiple-choice
examinations are probably not the best option. A meta-analysis performed by Kenneth
Feldman reveals that when examining the relative importance of various
instructional dimensions, both students and teachers rate the importance of
“quality of examinations” equally.4 These data suggest that instructors
do realize the importance of assessment, and that the logical next step is figuring
out what methods an instructor can use to achieve better alignment between the information
and skills to be learned and the assessment.
Although
much depends on the material being presented, possible options within the
health professional education include practical examinations, small-group
interactions, debates, peer assessments, or one-on-one standardized patient
interactions like the Objective Structured Clinical Examination (OSCE). One interesting
avenue of assessment includes the multiple choice item development assignment
(MCIDA), which requires students to “develop multiple choice items, write justifications
for both correct and incorrect answer options and determine the highest
cognitive level that the item is testing.”5 It is an interesting
twist on the traditional multiple choice exam in that the students write the
test instead of sitting for one. Although the author acknowledges that this
assignment can be time-consuming to grade, using the MCIDA enhanced learning
outcomes for students.
When it
comes to higher learning, some classrooms feature a battle between a
professor’s desire to lead a discussion in which students focus on the critical
thinking process and students’ desire to perform well on an upcoming
examination by focusing on “the bottom line.” If instructors can design their
course in a manner that promotes alignment between the critical thinking activities
of the classroom and the assessments used to test their students’ knowledge of
that material, they help ensure student success – not only on exams, but in
life.
References:
1.
Stehle, S, Spinath, B, Kadmon, M. Measuring Teaching Effectiveness: CorrespondenceBetween Students’ Evaluations of Teaching and Different Measures of StudentLearning. Res High Educ 2012;53:888–904.
2.
Stanger-Hall, KF. Multiple-Choice Exams: An Obstacle for Higher-Level Thinkingin Introductory Science Classes. CBE Life Sci Educ. 2012;11:294-306.
3.
Reeves, TC. How do you know theyare learning?: the importance of alignment in higher education. Int. J. Learning Technology 2006;2:294-309.
4. Feldman,
KA. Effective College Teaching from the Students’ and Faculty’s View: Matchedor Mismatched Priorities? Res High Educ 1988;28:291-344.
5. Fellenz,
MR. Using assessment to support higher level learning:
the multiple choice item development assignment. Assessment
& Evaluation in Higher Education. 2004;29:703-719.
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