Creating authentic assessments in higher education is a challenge. And it is particularly difficult in healthcare education, where roles and responsibilities for safe clinical care are dependent on skills and knowledge acquired at university.
We have used case-based discussions as a solution to this. This assessment method is a novel one that requires students to submit a summative 1,000-word “case” – a patient specific to the module focus – using a templated structure. The electronic submission of the case is a prerequisite for taking the summative assessment: a 20-minute (Level 6) or 30-minute (Level 7) online, recorded critical discussion of the case.
An academic and a clinical specialist assess the student, asking structured questions and completing the marking rubric. Summative assessment success is supported by two formative assessments, a case discussion with peers and an outline of the case.
Why case-based discussion?
We found the use of case-based discussion to be an authentic and inclusive assessment. It is also an efficient assessment method for time-pressed students and teachers. We would argue that this assessment method is authentic because learners in health subjects are far more likely to undertake a professional discussion about a clinical case than to write, for example, a lengthy essay. We advocate for this authentic assessment as a basis for enhancing inclusivity, since it uses a method that is integrated with the real-world experiences of the learners: the ability to articulate and defend cases.
As with previous viva findings, the use of case-based discussion receives highly positive student feedback, and students suggest it facilitates both learning and consolidation and the development of critical discussion skills. Although some students felt nervous before the discussion, all said they felt confident discussing their case. Staff perceive that the assessment method affords students a good opportunity to demonstrate their understanding, although there were limitations for non-native English speakers. This is worth bearing in mind during the assessment process.
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Based on our experiences, below are tips for success:
Adopt a student-led approach: we allowed students to select their own assessment time and date. This was well received by students, although assessors felt somewhat fatigued by back-to-back assessment.
Look after the assessors: provide 10-minute breaks between students to allow staff to recover, complete the marking rubric and familiarise themselves with the next case.
Credibility is key: ensure a clinical specialist is present to bring credibility to the assessment process. In our case, the presence of two assessors negated the need for moderation and facilitated synchronous decisions and rubric completion. As such, this proved a highly efficient assessment method.
Formative assessments are important: provide a formative assessment that reflects terms and conditions of the summative to reduce student anxiety and increase familiarity with assessment criteria.
Provide a structure for the case: use a template to help standardise the case presentations, and ensure students include important details such as patient age, presenting symptoms, previous medical history, etc.
Set a word limit: predefined word limits (these can vary depending on academic level) to ensure sufficient information is submitted for consideration before the assessment so that students can consider the case holistically.
Predetermine the questions: preselect assessment questions to standardise the process. For example, ask all students to explain, using evidence to support, their decision-making in relation to care management.
Use a marking rubric: dual assessment and a marking rubric enhance the marking process. Allowing students to select their assessment slots gives them flexibility and autonomy.
Case-based discussion yields positive student and assessor feedback. It provides important opportunities for collaboration with clinical colleagues and facilitates critical discussion of important cases in a credible, real-world format. We encourage others to consider adopting it as an effective assessment method.
Rebekah Hill, Kelda Folliard, David Sturgeon and Katie Beck are educators in the School of Health Sciences at the University of East Anglia.
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