Narrative Assessment of Medical Students in a Human Structure Course

Abstract

Formative feedback that provides learners with a description of their strengths and recommendations for improvement plays a central role in medical education as it can promote self-reflection and professional development. Although this form of assessment is more prevalent in clinical education, LCME standards require “ … a narrative description of a medical student's performance, including his or her non-cognitive achievement … whenever teacher-student interaction permits this form of assessment.”1 To provide a narrative assessment (NA) of student performance in a large medical school class is challenging. Here, we present the methodology used in the Human Structure Course at UT Southwestern Medical School. This pre-clerkship course is taught to about 230 students each year and combines Anatomy, Embryology and the basics of Radiology. Prior to the COVID-19 pandemic, the course was dissection-based, but was conducted entirely online in 2020, when the NA procedure was implemented. To emulate the regular dissection experience, small groups of 2-3 students synchronously met in Zoom Breakout Rooms to study a given body region using 3D-Anatomy software together with our own dissection guide and dissection videos. The NA was based on observations faculty members made while joining the small groups in their Breakout Rooms. A rubric with three categories (“Preparation and Knowledge”, “Teamwork”, and “Feedback”) was used to categorize the observed behavior of individual students. To construct the NA, faculty members could choose appropriate comments from provided lists as well as write individual comments on the strengths and areas for improvement for each of the categories. All observations were recorded in a FileMaker application database. The records were then transferred to the Data Mart maintained by the Office of Medical Education, where the observations and comments comprising the NA were converted into cohesive individual reports, which were made available to the students. We aimed at providing six NAs for each student over the course of 11 small-group sessions. To achieve this goal, on average, each faculty member needed to observe and comment on 12-13 students per session. As the students did not spent as much time in their Breakout Room sessions as initially anticipated, faculty members were not always able to observe all students assigned to them during a given session. However, of the 229 students in the class, 58% received all 6 reports, 28% received 5, and 12% received 4 reports. Less than 2% of the students received only 2 or 3 reports. Once the reporting mechanism was fully established, we were able to send the individual reports to the students within 48 hours after the session. In summary, the established procedure allowed us to regularly provide timely narrative feedback to a large class. The greatest limitations were constraints on the time for teacher-student interactions and some inconsistencies in the use of the rubric by faculty. In general, students found the NA helpful, but many requested more individualized comments. In the future, the NA will have to be adapted to a dissection-based course and additional faculty development is desirable. 1Liaison Committee on Medical Education,Standards for Accreditation of Medical Education Programs Leading to the MD Degree.