Key Assessment Strategy principles: Progressive, sequenced and connected, shared and balanced; clear assessments and criteria, practice and feedback; collaboration and feedback, has value beyond the classroom, dialogue and critical thinking
What is the assessment approach?
In Year 3 of the Medicine (MBChB) programme and as part of the Prescribing Safety Assessment unit in Year 5, students take part in a formative two-stage exam designed to help prepare them for a summative written exam.
Like the summative exam, the formative two-stage exam consists of multiple-choice and ‘single-best-answer’ questions. Used extensively in medical education, single-best-answer questions require students to make contextual, value judgements about the best diagnosis or treatment from five options, each of which could be ‘correct’.
In the first stage, students sit the exam individually; in the second, they form groups of five or six and take the exam again as a group, discussing their answers before submitting them via Microsoft Forms, Mentimeter or the Blackboard Collaborate polling tool.
How is feedback given?
Students receive feedback on their exam performance immediately after submitting their answers in both the first and second stage. They also have opportunities to engage in peer feedback when working in groups in the second stage, and to engage in further discussion with the tutor.
How is this approach different? What are some of the design features?
Traditionally, the two-stage exam has been used as a summative assessment, with students awarded marks for both the individual and group component. On the medical programme, it is assessment for – not of – learning. Meanwhile, the group component differentiates the approach from a standard mock exam; it is an opportunity for students to learn through collaboration as well as practice.
Having experimented with different learning environments, staff have found that formative two-stage exams work best in classrooms where students can sit around tables. Online and hybrid settings can also be effective, particularly when students are working in remote locations, as they can allow teams to discuss their answers without being overheard.
What was the rationale for this approach? What problems or challenges was it trying to address?
Part of the reason for introducing formative two-stage exams in Year 3 was to help students become more familiar with single-best-answer questions, an assessment type they are unlikely to have encountered, and support each other through peer learning.
“They’re not going to go in and just know the answer. They need to be able to take the clinical scenario they’ve been given and work out the relevant points. It’s something they need to learn to do and practise, and this is a very good way of helping them. I teach them how to do it in revision sessions, but I wanted them to be able to teach each other too.”
– Judith Fox
“Something we’ve been trying to do in group work is focus on cooperation, not competition. An exam where you’re assessed on your learning in a group format rather than as an individual is so beneficial if you look at the end product. You are not a better clinician if your friend makes a mistake. That mistake affects everybody. Safe prescribing is something we all have a vested interest in. This format really focuses students on the fact this is a cooperative process. It also prepares them for the job: ‘If you’re not sure, ask someone next to you. Don’t gamble.’”
– David Rogers
How does this approach reflect the strategic priorities of Integrated Assessment Design, Designed for All and Authentic Assessment?
Integrated Assessment Design
In preparing students for summative exams, formative two-stage exams emphasise the progressive nature of assessment and highlight the role of peer and tutor feedback in helping students learn. In developing students’ confidence to commit to answers and in encouraging teamwork and collaboration, it enables students to become insiders to the ways of thinking and acting in the discipline.
“Medicine is a multidisciplinary career. The more they keep working as a team rather than trying to beat each other, the better… They are competitive, and this approach fosters teamworking: ‘I don’t know this answer, but I know a person who does.’”
– Judith Fox
Designed for All
Formative two-stage exams are inclusive because they provide students with equal opportunities to prepare for their summative exams and ensure everyone gets as ‘authentic’ an experience of the exam as possible. Students have opportunities to learn not only from engaging in practice tasks, but also from dialogic formative peer feedback in small groups during the second stage.
“When they were going through things in a group, they could help each other in a way that with just direct delivery to a large cohort, we wouldn’t be able to.”
– Judith Fox
The approach is also inclusive in the sense that students are motivated to attend and engage in discussions with their peers, even if they are not well prepared.
“They feel part of the team. They’re willing to contribute their little bit of knowledge rather than feel overwhelmed if they haven’t done as much studying as their peers and just give up. I think that idea of the greater good allows them to feel less under pressure and enjoy it more.”
– David Rogers
Authentic Assessment
Formative two-stage exams promote teamworking and collaboration. This not only builds students’ confidence in explaining their decisions to peers, but also encourages them to ask peers if they feel unsure about a decision. It therefore mirrors professional practice, developing skills that have value for students beyond the classroom and beyond the exam.
“It’s going to make them into safer, better, happier and more resilient doctors. Being able to do things like ask questions and work in a team is essential for that.”
– Judith Fox
