Essays for a Large Medical School Class?

1. Essays for a Large Medical School Class? Amy L. Wilson-Delfosse, Ph.D. Associate Professor of Pharmacolgy Assistant Dean for Basic Science Education Case Western Reserve University

2. Why Test? • Assess understanding of key concepts

3. Why Test? • Assess understanding of key concepts • Assess application of concepts taught

4. Why Test? • Assess understanding of key concepts • Assess application of concepts taught • Assess problem solving, analytical reasoning, • critical thinking

5. Why Test? • Assess understanding of key concepts • Assess application of concepts taught • Assess problem solving, analytical reasoning, • critical thinking • Identify students who need remediation

6. Why Test? • Assess understanding of key concepts • Assess application of concepts taught • Assess problem solving, analytical reasoning, • critical thinking • Identify students who need remediation • Inform revisions to the curriculum

7. How to Test? Instructional Objectives/Goals

8. How to Test? Instructional Objectives/Goals Instructional Methods

9. How to Test? Instructional Objectives/Goals Instructional Methods Assessment

10. How to Test? Instructional Objectives/Goals Instructional Methods Assessment Align your assessments with your instructional goals!

11. CWRU’s re-alignment Pre-Western Reserve2 Curriculum Reform • Exams developed on a lecture-by-lecture basis where each faculty submitted 2-3 MCQ-items per hour—lacked integration and perspective • Minimal investment of faculty time • Students ‘binged and purged’ • Students challenged questions that weren’t covered in lecture

12. Assessments Should … Guiding Principles • Drive learning • Facilitate continuous rather than episodic learning • Promote supportive and collaborative relationship among students • Provide frequent formative feedback • Provide periodic judgments of students progress based on multiple methods of assessment both qualitative and quantitative

13. Design Features • Formative Assessments –Throughout the Course • Weekly 2 Synthesis Essay Questions (SEQs) • plus 20-30 MCQs • Summative Assessments—End of Course • Summative Synthesis Essay Questions (SSEQs)

14. SSEQs Summative Synthesis Essay Questions Goals • Test reasoning about content rather than content alone • Assess application of content and integration of concepts • rather than recall of isolated facts • Test integration of concepts within and across courses

15. SSEQs Summative Synthesis Essay Questions Construction • Each question should begin with a clinical scenerio • Emphasize higher order thinking skills, • e.g., application/comprehension/problem solving • State the question clearly • Offer guidelines and structure to the type of responses • expected to facilitate the job of grading • Template each essay with multiple parts • Engage a collaborative group of specialists to write

16. SSEQs Summative Synthesis Essay Questions Grading • Electronic exam system facilitates grading • Develop point structure for each subquestion and clearly • determine credit for each concept tested in advance • One content expert grades one subpart for entire class • Set final pass marks after analyzing performance of • the exam

17. SSEQs Summative Synthesis Essay Questions Time Requirements • Electronic exam system facilitates grading • Develop point structure for each subquestion and clearly • determine credit for each concept tested in advance • One faculty member grades one subpart for entire • class • Set final pass marks after analyzing performance of • the exam

18. SSEQs Summative Synthesis Essay Questions Example: Patricia Moran is a 26-year-old woman who is seeing her primary care physician for the first time. She has been treated for Graves‟ disease with propylthiouracil (PTU) in the past. She stopped taking the pill about a year ago because she felt fine and didn‟t think she needed it. Since then she has lost 20 pounds and says that she is unusually nervous. She is “hot and sweaty” all the time, and has hand tremors, and heart palpitations. Her periods are also scanty and she can go 2-3 months in between periods. She has noticed an increase in the frequency of her bowel movements. On physical examination, she has a very rapid heart rate of 120. Her skin is warm and moist, and feels unusually smooth and velvety. She has a fine tremor in her hands. She also has bilateral exophthalmos (eyes protrude from the orbits). Her thyroid gland is large and there is a thyroid bruit (rushing of blood when auscultating the thyroid with a stethoscope). Her deep tendon reflex (DTR) relaxation phase is very brisk. 6. (a) Explain what has gone awry with this patient’s thyroid gland and why her eyes are bulging forward, and (b) Using your knowledge of the normal physiologic effects of thyroid hormone on the body, explain how thyroid hormone causes the signs and symptoms noted above. 7. Explain the synthesis of thyroid hormone. In your answer, please explain regulation by the hypothalamic-pituitary-thyroid (HPA) axis and how thyroid hormone is carried in the blood. Also, explain why a serum TSH level is a useful test in this patient. 8. Explain the key cellular signal transduction steps by which TSH acts as a thyroid stimulating hormone. Include in your answer an explanation of the basic protein structure of the receptor for TSH and how TSH interacts with this receptor. Also explain the reactions at the cell surface, within the cytoplasm, and within the nucleus.

19. SSEQs Summative Synthesis Essay Questions Advantages Disadvantages Tests higher order thinking in an unprompted fashion Drives deep concept learning Informs curricular improvements Faculty time to write essays Faculty time to grade essays Increased time to grade release

20. SSEQs Summative Synthesis Essay Questions Advantages Disadvantages Test higher order thinking in an unprompted fashion Drive deep concept learning Informs curricular improvements Faculty time to write essays Faculty time to grade essays Increased time to grade release

21. Acknowledgements The Students and Faculty of the Western Reserve2 Curriculum Klara Papp, Ph.D. – Director of Medical Student Assessment

22. International Association of Medical Science Educators Annual meeting June 18-21, 2011 St. Petersburg, Florida Sponsoring Institution: University of South Florida