GW Study Examines Curriculum Design of Online Self-Assessment Exams

Dr. Pritha Ghosh posing for a portrait

Promoting self-directed learning (SDL) can be beneficial for medical student education, and a study published in Medical Science Educator by Pritha Ghosh, MD, assistant professor of neurology at the George Washington University (GW) School of Medicine and Health Sciences, offers curriculum design insight to promote SDL when using online self-assessment exams (SAE).

For the study, “Optimizing the Use of an Online Self-Assessment Exam to Promote Self-Directed Learning Behaviors in Medical Students,” the authors — who include Ghosh; former SMHS student Jeffrey Jacob, MD; Ellen Goldman, MBA, EdD, associate dean for faculty and organizational development and professor of clinical research and leadership at SMHS; and Nisha Manikoth, EdD, professorial lecturer in the GW Graduate School of Education and Human Development — applied adult learning principles to the curricular design for implementing an online SAE in a neurology clerkship.

“Through this study, we wanted to pilot the use of an online SAE in the neurology clerkship in order to foster SDL behaviors, and to assess its effectiveness in doing so through a student survey,” said Ghosh.

According to the study’s authors, SAEs are becoming increasingly popular in medical education, but use of such tools “requires careful application of adult learning principles to effectively encourage SDL behaviors in students.”

The researchers adjusted the curriculum for the clerkship, replacing the normal final exam with a self-paced neurology self-assessment exam and providing guidance with a library guide of resources and bi-monthly facilitated discussion sessions.

Students were then asked to complete an anonymous and voluntary survey on the curriculum redesign. 

All of the 150 students enrolled in the clerkship completed the SAE with a passing grade, with an average score of 79.34% compared to the national average of 69.11%.  

More than 91% of students who took the survey said they found the SAE helpful as a learning tool, noting that it broadened exposure to clinically relevant content. Factors in the curricular implementation of the SAE that further encouraged SDL behaviors were positioning the SAE as a learning tool rather than as a summative assessment, allowing for autonomy and flexible pacing, promoting spaced study, fostering collaborative confirmation of new knowledge structures through facilitated discussions, and providing a low-stakes extrinsic motivation to complete the exam. 

As use of online SAEs in medicine grow, there is greater opportunity to use them to promote self-directed learning, the authors noted, with this study providing more insight into curricular design.

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