Abstract
Examinations are a significant source of academic stress, particularly in the demanding environment of medical education. In order to reduce the burden of anxiety, burnout and depression among students, medical schools aim at reducing academic stress by exploring alternatives to frequent, high-stakes assessment schedules. The bundling of examinations into integrated block assessments has emerged as a successful strategy to reach this goal, as the resulting reduction in examination days can provide uninterrupted periods of study time that allows for a deeper understanding of material as well as an opportunity for students to take wellness breaks between exams. The present study examines the outcomes of a natural experiment on back-to-back exam scheduling in two related medical school courses post hoc. The outcomes of the scheduling change on the academic performance and satisfaction of examinees were analyzed with a mixed-methods approach. The data show that the transition from a spaced-out to a back-to-back exam schedule was accompanied by a drop in academic performance and student satisfaction with the curricular schedule. The data presented suggest that without proper curricular integration, the block scheduling of exams has negative effects on learning outcomes and student satisfaction.
Highlights
The assessment of learning outcomes is an essential element of curriculum design, but even well-designed assessments are a major source of stress and anxiety in University students [1]
While the methods and scheduling of assessments have a significant influence on the measured performance of examinees [2], advanced assessment strategies such as integrated block testing go beyond a mere improvement in measurement, and instead improve the actual learning outcomes of the curriculum [3,4]
While it seems obvious that the scheduling of exams can have a major impact on measured performance and student satisfaction, only a few studies have attempted to quantify scheduling effects on academic performance in isolation of any other curricular changes [7,8]
Summary
The assessment of learning outcomes is an essential element of curriculum design, but even well-designed assessments are a major source of stress and anxiety in University students [1]. In the demanding medical school curricula, with frequent high-stakes examinations, assessment formats and schedules are a major source of student stress [5], and need to be carefully designed to provide an authentic measure of learning, as well as to favor the understanding of key concepts over the short-term memorization of facts [6]. While it seems obvious that the scheduling of exams can have a major impact on measured performance and student satisfaction, only a few studies have attempted to quantify scheduling effects on academic performance in isolation of any other curricular changes [7,8]. The influence of time between exams on academic performance has been understudied, and the only available comprehensive data on such scheduling effects are limited to an analysis of the performance of high school students [2]. As was concluded at the time of implementation, SIS requires deliberate careful planning to leverage the benefits of content integration for more meaningful learning [10]
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