An Investigation of the Application of Different Methods of Student evaluation by clinical education groups of Birjand University of Medical Sciences

Problem statement:

 The aim of medical education is to develop the level of competence of students in accordance with educational programs (1) and assessment of educational progress is a systematic process to measure the achievement of these educational goals (2) which is one of the essential steps of the educational process. This helps professors in decision making regarding educational activities; also, it makes the students aware about their weak points that will ultimately result in their learning improvement (3). The assessment not only affects the outcome of student learning, but also affects the student's learning methods (4, 5). Professors also need an evaluation tool to differentiate between students based on their level of learning and the determination of a standard to learn different areas. The assessment of academic achievement in higher education is done with a variety of methods and tools, but the important thing is that the tools used should be able to measure the knowledge and skills that are targeted in the curriculum, in which case it will be determined whether the education has led to learning or not (6). In Iran, medical students have to undergo a seven-year classical course consisting of four levels of basic science, physiopathology, internship and externship, all grades being internally evaluated, and to enter the physiopathology and internship courses, a test is held across the country. The assessment method in the country tests as well as in the basic sciences and physiopathology courses are multiple choice questions. In the internship and externship, evaluation is also mainly conducted in a multi-choice approach, along with OSCE or DOPS (7). Given the increasing community demand for more accountability and responsibility of physicians, the need for accurate implementation of curriculum for more student empowerment and a more accurate assessment of these capabilities seems necessary. In those circumstances, students will be able to complete their professional duties after graduation. To this end, the application of different evaluation methods appropriate to each competency will be necessary (8). Based on Miller's Pyramid, different methods of evaluating the four domains of learning (cognitive, attitude, performance, and clinical reasoning) (9). The review of the studies of Mesrabadi (2011) (10), Mousavi and Maghami (2012) (11), and Komeyli and Rezaei (2012) in this field show that multiple-choice tests and descriptive tests are the most widely used evaluation methods (12). Kajouri et al. (2014) also found that more than 99% of the educational groups used the multiple-choice test for evaluation, and at a later stage, a variety of evaluation methods such as logbook, OSCE test, DOPS, practical test, anatomical test, oral test, practical test and Mini-Cex test are used (13). The results of the research show the impact of evaluation methods on the promotion of professional skills (14). Therefore, each test must be applied in a coherent way, as each type of test evaluates an aspect of learning (15, 16). In this regard, the use of blueprint can be helpful for the proper use of tests to measure different areas (17). As the study of medical research has shown, the challenges in the field of medical education assessment and the method of choosing the appropriate method of evaluation and the effects of choosing the correct methods, in accordance with the educational goals in each of the educational groups, the need to address this issue is emphasized as one of the current priorities of medical education. Given that any change in the learning process requires monitoring the current status so that its results can be used to make decisions and plan for the next steps to improve the quality of education, and given that no research has been done in Birjand University of Medical Sciences in this regard, the aim of this study was to determine the current status of the use of various educational progress tests in clinical groups of Birjand University of Medical Sciences.

 Methods:

This is a descriptive-cross sectional study conducted in the academic year of 2016-2017. In this study, all clinical departments of Birjand University of Medical Sciences including obstetrics and gynecology, internal medicine, heart, pediatric, neurology, ENT, surgery, psychiatry, orthopedics, ophthalmology, dermatology, radiology, anesthesiology, emergency medicine, and urology were assessed according to the type of evaluation of the students. Purposeful sampling method was used; an interested student was selected from each department. The reason for the selection of the student to assess was that the student is the best and only tangible source of evaluation (19-18). The reason for choosing a student for evaluation in each department was based on the nature of the use of the checklist, and its clarity and clear results. The inclusion criteria were passing the final test for each department and the exclusion criteria was dissatisfaction and unwillingness to continue. A researcher-made checklist was used to collect data. To create a checklist, firstly, a variety of medical students' assessment methods that are widely used are selected based on the review of the literature and aligned with the methods mentioned in the clinical curriculum. Finally, a checklist of evaluation in four areas of written method, evaluation by a supervisor physician, clinical simulator, multi-source or 360-degree assessment with 15 types of tests, which are in accordance with the Accreditation Council for Graduate Medical Education Model (ACGME) (20). The factual and content validity of the checklist were confirmed by the opinion of five medical education specialists. The methodology was implemented so that all selected students were trained on a variety of evaluation methods at a meeting aimed at acquainting students with the titles of evaluation methods, and then a checklist was designed to provide them with a type of assessment. In order to comply with ethical principles, information was provided without mentioning the names of the training groups and the students of the sample group cooperated with consent and awareness of the project. Finally, the data was entered into Excel 2010 software and analyzed and the results are shown in frequency and percentage in each group based on the department.

 Results: The results of this study showed that most of the tests conducted in internship and externship courses were in the field of written method, key test and history match, which was performed in 66.67% of clinical groups. In the area of ​​assessment by the observer physician, the oral test was used by 40% of the groups, and in the multi-source or 360-degree assessment group only 33 percent of groups used the work folder for evaluation, and in the field of clinical simulation, none of the tests were used for evaluation in any of the groups. In Tables 1, 2, and 3, different types of tests are shown based on their use in each of the clinical groups and in basic sciences and clinical sciences.

Table 1: The frequency of written tests used in clinical groups

 Table 2: The frequency of tests in the assessment by the supervisor physician in clinical groups

Table 2: Frequency of tests used in the clinical simulation in clinical groups