TEACHING AND ASSESSMENT METHODS

1. TEACHING AND ASSESSMENT METHODS By UcheOnwudiegwu, MB,ChB; FWACS, FICS, IFME (FAIMER), Cert. Intl. Hlt. (Harvard), Cert. Med. Educ.(UIC, Chicago), Cert Med. Educ. (SIU, Springfield), Cert. Reprod. Hlt & Devpt. (JHU, Baltimore) Professor of Obstetrics/Gynaecology & Medical Education Specialist

2. TEACHING METHODS: LEARNING OBJECTIVES • To review teaching methods • To highlight the qualities and characteristics of effective medical or health professions teaching. • To identify the necessary ingredients necessary for achieving teacher effectiveness. • To stimulate teachers to effective teaching.

3. *INTRODUCTION • Competence is defined as the simultaneous integration of knowledge, skills, and attitudes required for performance in a designated role and setting. Spencer et al (1994). • Successful performance in any profession or field of endeavour requires formal or structured training so that the trainees are equipped and enabled with the appropriate and integrated knowledge, skills and attitudes. • Teachers themselves who are trainers need to be adequately equipped and enabled to effectively train the trainees to achieve competence in their fields.

4. *INTRODUCTION 2. • From everyday experiences teaching can be done instinctively by showing and guiding another to do what one had seen and learnt i.e. ‘see one, do one, teach one’ principle. • Such training however remains unstructured, opportunistic and non-standardised. It will not achieve commendable quality or reliability. • Teaching is not an end in itself. It is only a process by which learning is effected. Learning is the end point or terminal objective of teaching. • Untrained minds envisage teaching as an end point, a simplistic passage of information to an audience, while trained hands are ever conscious to ensure that the end point of learning is achieved.

5. *INTRODUCTION 3. • Most teachers in Nigerian Medical Schools do not have professional or formal training in imparting knowledge, though they are experts in their various fields (i.e. content experts). Yet the theories and principles of teaching and learning are a well researched field which are applicable in teaching. • Expertise in a field does not confer or translate automatically to effective teaching. A brilliant academic does not automatically translate to a brilliant or effective teacher. • Worldwide, high quality training and education of health professionals is increasingly recognised as critical to global health and emphasis is therefore being made that the training of such health professionals be done by professionally competent teachers

6. PEDAGOGY • Pedagogy can be defined as the principles and methods of instruction OR • The activities of educating or instructing or teaching OR • Activities that impart knowledge or skill • Effective pedagogy utilises established educational theories and principles.

7. *WHAT IS LEARNING? • Learning is a process that results in some modification, relatively permanent, of the way of: • Thinking (Cognitive), • Feeling/Conduct/Attitude (Affect), • Doing (Psychomotor skill) of the learner. • Learning is often a gradual, adaptable and selective process resulting from practice, repetitions and experience. • The understanding of how people think and learn is necessary in equipping the teacher in his duties. • *Reflective, conceptual, creative or practical thinkers access new information in different ways. • Similarly learning styles of students differ: auditory, visual, kinaesthetic and environmental learners

8. SOME TEACHING METHODS • Lecture • Tutorial • Seminar • Bedside • Clinic/OR –based • Grand Round • Small groups discussions • Demonstrations/Practical sessions • Role Play • Personal/Group Assignments • **Clinical Skills Laboratories: mannequins, animal/human models, Standardized Patients. • **Simulators/Simulations

9. *EFFECTIVE TEACHING • The effective teacher must : • Know his/her subject (content expert) • Know his/her audience (students) : their needs, educational attainment, level of maturity and their environment. • Understand educational theories and foundations and how to apply them. • Understand the Principles of Teaching and Learning. • Must adopt the appropriate teaching strategies or methodologies for his/her subject and audience. • Must develop a lesson or teaching plan with timeline.

10. *EFFECTIVE TEACHING 2 • Introduce the topic/subject of study in an interesting manner. • Have learning objectives to guide him/her • Break his/her subject into smaller headings or portions • Use appropriate teaching aids in his/her delivery • Give a summary in between sections and at the end • Give a conclusion (and/or recommendation) • Must always call for feedback from students • An effective teacher does not only teach but ensures that learning takes place • The essence of teaching is to effect or facilitate learning which brings a desired change

11. *EFFECTIVE TEACHING 3 • Effective teaching requires well trained and motivated teachers. • It requires investment in modrn teaching facilities. • It demands teacher evaluation on continued basis for improvement of individual output as well as more effective learning of students.

12. *CONCLUSORY REMARKS • In our context, the medical teacher or health professions teacher to be effective must be able to understand the building blocks of curriculum, educational foundations and theory, modern assessment methods and teaching effectiveness among others. • A review of the need for teacher training among United Kingdom medical teachers shows tremendous advances. • Summarising various publications on the issue3-9., the British Medical News10stated inter alia “All doctors in the UK are required to teach future generations of doctors, yet, unlike the preparation provided for their roles as clinicians and despite their expertise in what they teach, there has traditionally been a deficiency in appropriate teacher education in the medical profession.

13. *CONCLUSORY REMARKS …2 • The role of doctors as teachers is increasingly recognised as a core professional activity that should not be acquired through chance, aptitude or inclination alone. Although subject expertise is important, it is unacceptable to assume that because a doctor knows a lot about their subject, this will enable them to teach it effectively either formally or informally” • This is a summary call for training for all teachers in health professions education for effectiveness.

14. *ASSESSMENT • Assessment is an important and critical component of overall instruction. • Properly used it aids in accomplishing key curricular goals. • Tests are powerful motivators and students will learn what they believe is of value. • Assessments fill instructional gaps by encouraging students to read broadly on their own. • It also determines final grades or makes promotion decisions. • Assessments also identify areas where the course/curriculum is weak and provide remedy. • It is important that teachers are very familiar with assessment principles and the methods of assessment that have attendant high psychometric properties.

15. *STUDENTS ASSESSMENT • Why Assessment?: • To motivate students to learn • To guide students and teachers • To certify (competence) • Types of Assessment: 1. Formative (non-consequential): • To provide feedback to students, teacher and program. • To help identify areas of deficiency or weakness and rectify same. • 2. Summative: At the end of course, for judgment Pass or Fail, No rectification. • Nature of Assessment: • Should be Continuous, Diagnostic, Criterion referenced, Valid and Reliable. • What to Assess: Cognitive, Affect, Psychomotor skills

16. *SCOPE OF ASSESSMENT • Examination content should always match course/clerkship objectives. • Important topics should be weighted more heavily than less important topics. • The testing time devoted to each topic should reflect the relative importance of the topic. • The sample of items should be representative of instructional goals. • Performance on the sample is the basis for estimating achievement in the broader domain of interest. • The nature of the sample determines the extent to which the estimate of true ability is reproducible (reliable, generalizeable) and accurate (valid).

17. *SCOPE OF ASSESSMENT 2 • If the sample is too small, examination results may not be stable enough to ensure they reflect true ability. • With broad samples, peaks and valleys in performance tend to average out. • A variety of testing methods (Essays, SAQs, MCQs, Practical Clinical examinations etc.) should be used as no one method can assess all the skills of interest. • Most importantly, all cognitive assessment must endeavour to cover the seven areas as enunciated by Bloom.

18. WRITTEN ASSESSMENT • Written assessment remains a valid instrument for testing cognitive ability. • Cognitive knowledge includes all learning or achievement that is associated with mental ability or function. • MCQs and SAQs should be mostly used because of better objectivity, reduced inter-rater and intra-rater variability, higher content validity and higher reliability compared with Essay questions. • High quality, flaw-free MCQs such as EMQs are more difficult to set and require training. • EMQs can test higher cognitive functions. A true/false MCQ type is of lower value than EMQs as a test instrument.

19. *Desirable Characteristics of Cognitive Tests 1 • 1. Objectivity (agreement among content experts on the correctness of a response) • 2. Validity Evidence: Test scores (marks scored) must be supported with evidences that: i. The content domain is adequate. ii. The qualification and expertise of the item writers, test constructors and scorers is appropriate . iii. The conduct of the examination is appropriate, standard and fair. iii. There is statistical relationship with other measures of achievement.

20. *Desirable Characteristics of Cognitive Tests 2. • 3. Reproducibility (Reliability): ability to independently reproduce about the same test results to same examinees second time, all things equal. • Reliability of a test or examination is calculated on a scale of 0.0 to 1.0 with 1.0 representing error free measurement • The goal is to reduce measurement error as much as possible so that score reliability is above 0.8 (Cronbach’s α)

21. *Desirable Characteristics of Cognitive Tests 3. • 4. Defensibility: Test scores and decisions based on them must be defensible. Validity evidence is important to defensibility. • *Defensibility refers to data to support or refute argument for the legitimacy and reasonableness of inferences or decisions made from the examinations e.g. pass or fail. • Other defensibility criteria: Due diligence, determination of passing scores (e.g. modified Angoff) • Efficiency: Refers to time and cost, ease of test development, administration and scoring. Selected-response items generally are more cost efficient in this regard.

22. OTHER ASSESSMENT METHODS • *Objective Structured Clinical Examination (OSCE) • *Objective Structured Practical Examination (OSPE). • *Objective Structured Long Case Examination Record (OSLER) used in the UK. • *Practical Assessment of Clinical Examination Skills (PACES) used in the UK. • *Competency-based assessments • Case Reports/Commentaries • Research Projects/Dissertations • Research Publications/Patents • Log Books • *Portfolios/*Peer Assessment/Referees’ Reports • Oral Examination (viva voce)

23. *SUMMARY • The hallmarks of quality assessment in medical education are objectivity, structure, standardisation, validity, reliability and fairness. • Even viva voce (oral examinations) are being continuously structured and standardised to achieve objectivity and fairness. • Overall, ideal assessment methods must attempt to cover all learning domains according to Bloom’s taxonomy of learning domains. • This means that assessment must not be skewed: basic knowledge (recall), understanding, application, analysis, synthesis, evaluation and creativity must be adequately covered. • Furthermore, appropriate investment must be made in facilities for both teaching and assessment.

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