Melbourne Medical School Collected Works - Theses
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ItemPost-test feedback: knowledge acquisition & learning behaviours( 2015)This study, situated within the conceptual framework of assessment for learning, was motivated by the desire to find a practical way of providing informative and useful post-assessment feedback to medical students. The work was informed by the theories of test-enhanced learning and the principles of good feedback. It employed mixed methods to explore the impact of the study interventions on learning behaviour and knowledge acquisition. Set within an authentic medical educational setting, this study modelled an innovative method for production and distribution of individualised feedback reports following written multiple choice assessment. Year two students in a graduate entry medical program received four modified progress tests during their academic year and were randomised into three feedback groups. Feedback formats were selected to provide information about performance and guidance for learning without requiring release of test questions and answers. All feedback groups received test scores and some form of instruction based elaboration. Two groups were provided with variations of item level verification and instruction based elaboration, while the other group received normative data with general (rather than item level) instruction based elaboration. Outcomes of interest included study diaries, progress test scores, summative examination results, questionnaires and semi-structured interviews. Triangulation of the research data was used to interpret results. Outcomes from this study suggest there was a learning benefit from the test and feedback interventions. It appears that this benefit was achieved through direct interaction with the tests, and through the ability to self-monitor levels of knowledge and evaluate the effectiveness of study activities. Behaviour changes identified as a result of the study interventions included general study prior to tests, increased study following tests and feedback, and altered study behaviours involving different content, techniques and study aids. Of the three feedback types provided in this experiment, feedback consisting of grades, general instruction based elaboration and normative comparison appeared to be most easily interpreted and provided motivation for study, but resulted in inferior performance for students in the lower quartile of the cohort. This experiment demonstrates that it is feasible to produce and distribute individualised post-test feedback reports following paper based clinical vignette MCQ tests within a clinical learning environment. It highlights the potential of regular formative assessment to play an important role in directing focus of study and clarification of expectation of study depth and breadth. Medical students are often considered a relatively homogenous and high achieving cohort, yet results of this study suggest their responses to feedback are influenced both by the type of feedback information provided and the students’ relative ability within their learning cohort.
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ItemUnderstanding the nature of medical students reflection on learning and how it relates to feedback: an exploratory study( 2013)While there is a theoretical basis for the relationship between reflection on learning and feedback, there are still very few studies that provide empirical data about their relationship. To frame the study, a reflection on learning model was developed based on thorough theoretical and conceptual analysis. The analysis demonstrated that for students to be able to reflect on learning they need to have adequate internal motivation and self-efficacy, along with the appropriate level of cognitive and metacognitive skills and also proper feedback-seeking behaviour. Two separate studies were carried out to explore each of the two components and suggest best practice in feedback provision and a standardized way of measuring reflection on learning. This approach should advance our understanding of the nature of medical students’ reflection on learning and how it relates to feedback. Using the reflection on learning framework, the first study was conducted to determine the most appropriate instrument to measure medical students’ reflection the learning. Study one described the adaptation of the Motivated Strategies for Learning Questionnaire (MSLQ) to suit medical students learning context. The MSLQ was obtained through a systematic review of existing literature and was considered to be the most suitable instrument to measure reflection on learning. It has undergone expert panel review, pilot testing and a validation study with two groups of medical students to further establish its suitability. The findings in study one revealed that the modified MSLQ consisted of four factors: self-orientation, critical thinking, self-regulation and feedback seeking. These factors were compatible with the reflection on learning model developed as the conceptual framework in the present study. Using the modified MSLQ medical students reported only moderate reflective learning ability. Study two investigated the current process of feedback provision to medical students in the Mini Clinical Evaluation Exercise (Mini-CEX) setting. Five perspectives were pursued in order to understand how feedback was delivered and received: 1) non-participant observation of Mini-CEX, 2) analysis of Mini-CEX assessment forms, 3) structured interviews with medical students, 4) obtaining students’ perceptions of Mini-CEX feedback provision through questionnaire, and also 5) structured interviews with clinical teachers. The exploration of the feedback process in the Mini-CEX setting indicated that the feedback process was viewed as a one-way communication where students were unlikely to reflect on their learning experiences. The focus of the process was on teachers who transmitted information, whereas students’ roles and responses in receiving feedback received less attention. These approaches were not conducive for the development of reflective learning ability. The important implication of these findings is that both teachers and students need training in reflective learning practice. Both parties need to understand the concept of reflective learning in which feedback is one of the influencing factors on reflective learning. Teachers need to be trained to deliver feedback within a two-way communication process to help students develop their reflective learning ability.