Integrated Testing

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Integrated Testing

• Block Testing for Second Year Medical Student
  Courses

Sid Murphree, Department of Pathology University
of Louisville
Course Directors Section / APC meeting July 2006
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Sequence

• Why we migrated to block testing
• Current Block Testing Procedures
• Problems and Benefits

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Why we migrated to block testing?

• To encourage more effective student study
  habits
• Better prepare students for Step I
• Facilitate faculty and student integration
  of second year content
• Avoid intercourse

• inter course competition

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Curriculum OverviewSecond year

• Separate courses based in a single department
• Pathology
• Micro
• Genetics
• Pharm
• Introduction to clinical medicine
• Not integrated (hardened silos)
• not tests
• not lectures
• not schedules

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Fall of MS2 year
Studying for micro
Micro (6 tests)
test
Midterm
End of Term
test
Path (4 tests)
Studying for path
Genetics (1 test)
Studying for genetics
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and the following year
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Fall of MS2 year
Micro (6 tests)
Path (4 tests)
Genetics (1 test)
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and the following year
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Fall of MS2 year
Micro (6 tests)
Path (4 tests)
Genetics (1 test)
End result.. Test every Monday for most of the
fall
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Sequence effects during midterm test week and
end of term test week
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Midterm week
Fri
Path scores high micro scores low
Mon
Fri
Path
Micro
Other
Genetics
Fri
Micro scores high Path scores realy low
Micro Final!!!
End of term week
Don't worry there are two more path test in
January
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Faculty and student feedback

• Erratic lecture attendance
• Binge and Purge Learning
• Reliance on short term memory
• Little long term retention
• No integration of concepts / diseases
• Highly variable test item quality and formats!!
• Course competition....!!!

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Faculty and student feedback

• No personal lives
• Student attitudes and study habits driven by
  weeks of unrelenting stress and paranoia
• Generally poor Step I scores
• Unacceptable level of failures among first time
  takers

• Non-reinforcing shallow waves of attention

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Block Testing
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Block Testing Principles

• One large integrated test
• All major high stakes testing can only be done
  via the block test (short low stakes quizzes OK)
• Block test every 5 or 6 weeks
• Study week (Mon Thurs) leading up to BTon
  Friday
• Peer review each other tests questions
• Common guidelines for question formats
• 2 to 3 questions per hour of student contact
  randomly intermixed and divided into 50 minute
  sections

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Block Testing Organization and Timetable
Blocktest 1
Blocktest 2
Blocktest 3
Blocktest committee
Blocktest committee
Path
Micro
ICM
Genetics
Path
Micro
ICM
LXR used as database and to generate paper tests
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Results

• Course Directors have more in-depth knowledge of
  the content of all courses conducted in the MS2
  year
• More meaningful inter course integration
• Joint sessions
• Test items with shared stem or shared vignette
• Dramatic improvement in the quality of the
  questions used into the test
• Test much more like Step I

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Results

• Significant change in the students study
  habits
• Creating patterns of study more conducive for
  life long learning
• Consistent study of all topics over the time
  frame of the block test
• Time for integration of content
• Improved quality of personal life

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Results

• Slow continuous improvement in NBME 1 scores
• Block testing expanding into second year

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Problems

• Students who relied on last minute cramming
  struggled or failed. !!!
• May create additional difficulties for at-risk
  students
• Getting test questions from individual faculty
• Technical problems
• scanning / grading
• grade separation

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Questions

• Which is more important
• integrated testing
• integrated teaching
• Your questions

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