Essays for a Large Medical School Class?

Essays for a Large Medical School Class?

Amy L. Wilson-Delfosse, Ph.D.Associate Professor of Pharmacolgy

Assistant Dean for Basic Science EducationCase Western Reserve University

Assess understanding of key concepts

Why Test?Why Test?


Assess application of concepts taught

Why Test?Why Test?



Assess problem solving, analytical reasoning, critical thinking

Why Test?Why Test?




Identify students who need remediation

Why Test?Why Test?

Why Test?Why Test?




Identify students who need remediation

Inform revisions to the curriculum

How to Test?How to Test?

Instructional Objectives/Goals



Instructional Methods




Assessment


Align your assessments with your instructional goals!



Assessment

CWRU’s re-alignmentCWRU’s re-alignment

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

Pre-Western Reserve2 Curriculum Reform

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

Assessments Should …Assessments Should …

Guiding Principles

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)

Design FeaturesDesign Features

SSEQs SSEQs Summative Synthesis Essay QuestionsSummative 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


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


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


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

SSEQs SSEQs Summative Synthesis Essay QuestionsSummative Synthesis Essay QuestionsExample: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.


Advantages Disadvantages

Faculty time to write essays

Faculty time to grade essays

Increased time to grade release

Tests higher order thinking in an unprompted fashion

Drives deep concept learning

Informs curricular improvements


Advantages Disadvantages

Faculty time to write essays

Faculty time to grade essays

Increased time to grade release

Test higher order thinking in an unprompted fashion

Drive deep concept learning

Informs curricular improvements

AcknowledgementsAcknowledgements

The Students and Faculty of the Western Reserve2 Curriculum

Klara Papp, Ph.D. – Director of Medical Student Assessment

International Association of Medical Science Educators

Annual meeting

June 18-21, 2011

St. Petersburg, Florida

Sponsoring Institution: University of South Florida

Essays for a Large Medical School Class?

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