Summative assessments are more powerful drivers of student learning than resource intensive teaching formats

Tobias Raupach,Gerd Hasenfuss,Sigrid Harendza,Sven Anders,Jamie Brown

doi:10.1186/1741-7015-11-61

Abstract

BackgroundElectrocardiogram (ECG) interpretation is a core clinical skill that needs to be acquired during undergraduate medical education. Intensive teaching is generally assumed to produce more favorable learning outcomes, but recent research suggests that examinations are more powerful drivers of student learning than instructional format. This study assessed the differential contribution of teaching format and examination consequences to learning outcome regarding ECG interpretation skills in undergraduate medical students.MethodsA total of 534 fourth-year medical students participated in a six-group (two sets of three), partially randomized trial. Students received three levels of teaching intensity: self-directed learning (two groups), lectures (two groups) or small-group peer teaching facilitated by more advanced students (two groups). One of the two groups on each level of teaching intensity was assessed in a formative, the other in a summative written ECG examination, which provided a maximum of 1% credit points of the total curriculum. The formative examination provided individual feedback without credit points. Main outcome was the correct identification of ≥3 out of 5 diagnoses in original ECG tracings. Secondary outcome measures were time spent on independent study and use of additional study material.ResultsCompared with formative assessments, summative assessments increased the odds of correctly identifying at least three out of five ECG diagnoses (OR 5.14; 95% CI 3.26 to 8.09), of spending at least 2 h/week extra on ECG self-study (OR 4.02; 95% CI 2.65 to 6.12) and of using additional learning material (OR 2.86; 95% CI 1.92 to 4.24). Lectures and peer teaching were associated with increased learning effort only, but did not augment examination performance.ConclusionsMedical educators need to be aware of the paramount role of summative assessments in promoting student learning. Consequently, examinations within medical schools need to be closely matched to the desired learning outcomes. Shifting resources from implementing innovative and costly teaching formats to designing more high-quality summative examinations warrants further investigation.

Highlights

Electrocardiogram (ECG) interpretation is a core clinical skill that needs to be acquired during undergraduate medical education
The highest level of teaching intensity, consisted of eight 45-minute small-group sessions facilitated by near-peers, that is, medical students in their fifth year who had been trained as student teachers according to current recommendations [20]
Confirming our hypothesis, we found a strong association between summative examinations and better performance in the ECG exit examination while teaching intensity did not predict student performance

Summary

Introduction

Electrocardiogram (ECG) interpretation is a core clinical skill that needs to be acquired during undergraduate medical education. This study assessed the differential contribution of teaching format and examination consequences to learning outcome regarding ECG interpretation skills in undergraduate medical students. Most medical school curricula have adopted innovative teaching methods such as problem-based learning [1] and student-led peer teaching [2] According to their theoretical underpinnings [3], these are thought to enhance student learning, performance in examinations and, eventually, clinical competence. The axiom ‘assessment drives learning’ [7] has been widely accepted as a fundamental rule of medical education, even to the extent of characterizing assessments as ‘educational tools’ [8] This wide acceptance is despite a substantial lack of high-quality research into the nature of the association between assessment and learning [9]. Given the substantial resource requirements of some innovative teaching methods, knowledge of their impact on student learning relative to the impact of assessments is important from a cost-effectiveness point of view

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