Strategic choices in curriculum design to facilitate knowledge and competency development

Een succesvolle opleiding vraagt om strategische keuzes die leiden tot een goede afstemming tussen wat studenten leren, hoe we dit ondersteunen en hoe we dit toetsen. Competentiegericht onderwijs richt zich vooral op wat studenten moeten kunnen aan het eind van hun opleiding. De weg daarnaartoe en bijbehorende toetsing zijn niet altijd even duidelijk. Daar gaat dit proefschrift over. We beschrijven de opzet van een competentiegerichte basisopleiding geneeskunde en vergelijken de prestaties van haar studenten met die van studenten uit het voorgaande curriculum. Aan het eind van de opleiding vonden we nagenoeg geen verschillen wat betreft, medische kennis, prestaties op de kliniek of de mate waarin studenten zich voorbereid voelden op de praktijk. Aandacht voor competentieontwikkeling ging dus niet ten koste van andere belangrijke onderwijsuitkomsten. We onderzochten ook de haalbaarheid van langere coschappen, wat de competentieontwikkeling van studenten zou bevorderen. Hieruit bleek dat, ondanks dat studenten niet meer op elke afdeling kwamen dit niet ten koste zou gaan van de ontwikkeling van bepaalde competenties of disciplinespecifieke kennis. Tenslotte onderzochten we de effectiviteit van cumulatief toetsen, een specifieke manier van herhaald toetsen binnen een studieblok. Deze toetsmethode bleek zeer effectief in het stimuleren van zelfstudie. Studenten die eerst slecht presteerden, repareerden dit door het blok heen. Bovendien studeerden studenten 50% meer en begonnen zij veel eerder met studeren als er cumulatief getoets werd dan in een regulier toetsprogramma. Dit proefschrift biedt inzicht in de haalbaarheid en gevolgen van competentiegericht onderwijs en mogelijke ondersteuning van kennis- en competentieontwikkeling binnen dit onderwijs

Cumulative assessment:Strategic choices to influence students' study effort

BACKGROUND: It has been asserted that assessment can and should be used to drive students’ learning. In the current study, we present a cumulative assessment program in which test planning, repeated testing and compensation are combined in order to influence study effort. The program is aimed at helping initially low-scoring students improve their performance during a module, without impairing initially high-scoring students’ performance. We used performance as a proxy for study effort and investigated whether the program worked as intended. METHODS: We analysed students’ test scores in two second-year (n = 494 and n = 436) and two third-year modules (n = 383 and n = 345) in which cumulative assessment was applied. We used t-tests to compare the change in test scores of initially low-scoring students with that of initially high-scoring students between the first and second subtest and again between the combined first and second subtest and the third subtest. During the interpretation of the outcomes we took regression to the mean and test difficulty into account. RESULTS: Between the first and the second subtest in all four modules, the scores of initially low-scoring students increased more than the scores of initially high-scoring students decreased. Between subtests two and three, we found a similar effect in one module, no significant effect in two modules and the opposite effect in another module. CONCLUSION: The results between the first two subtests suggest that cumulative assessment may positively influence students’ study effort. The inconsistent outcomes between subtests two and three may be caused by differences in perceived imminence, impact and workload between the third subtest and the first two. Cumulative assessment may serve as an example of how several evidence-based assessment principles can be integrated into a program for the benefit of student learning

Influence of feedback characteristics on perceived learning value of feedback in clerkships: does culture matter?

Background: Various feedback characteristics have been suggested to positively influence student learning. It is not clear how these feedback characteristics contribute to students' perceived learning value of feedback in cultures classified low on the cultural dimension of individualism and high on power distance. This study was conducted to validate the influence of five feedback characteristics on students' perceived learning value of feedback in an Indonesian clerkship context. Methods: We asked clerks in Neurology (n = 169) and Internal Medicine (n = 132) to assess on a 5-point Likert scale the learning value of the feedback they received. We asked them to record whether the feedback provider (1) informed the student what went well, (2) mentioned which aspects of performance needed improvement, (3) compared the student's performance to a standard, (4) further explained or demonstrated the correct performance, and (5) prepared an action plan with the student to improve performance. Data were analyzed using multilevel regression. Results: A total of 250 students participated in this study, 131 from Internal Medicine (response rate 99%) and 119 from Neurology (response rate 70%). Of these participants, 225 respondents (44% males, 56% females) completed the form and reported 889 feedback moments. Students perceived feedback as more valuable when the feedback provider mentioned their weaknesses (beta = 0.153, p <0.01), compared their performance to a standard (beta = 0.159, p <0.01), explained or demonstrated the correct performance (beta = 0.324, p <0.001) and prepared an action plan with the student (beta = 0.496, p <0.001). Appraisal of good performance did not influence the perceived learning value of feedback. No gender differences were found for perceived learning value. Conclusions: In Indonesia, we could validate four out of the five characteristics for effective feedback. We argue that our findings relate to culture, in particular to the levels of individualism and power distance. The recognized characteristics of what constitutes effective feedback should be validated across cultures

Autotransplantation of teeth with incomplete root formation:A systematic review and meta-analysis

Objectives The objective of this systematic review and meta-analysis was to determine the rates of survival and success and the complications related to autotransplantation of teeth with incomplete root formation. Additionally, we attempted to identify the prognostic factors that influence the outcome of tooth autotransplantation. Materials and methods A literature search for all data published until July 2016 was conducted. Inclusion and exclusion criteria were specified. Risk of bias was assessed with the Newcastle checklist. Meta-analysis was performed by using the DerSimonian-Laird random effect model. The 1-, 5-, and 10-year survival rates and the weighted estimated survival, success, and complication rates per year were calculated. Results Thirty-two studies were included for analysis. The survival rates reported after 1, 5, and 10 years were 97.4, 97.8, and 96.3%, respectively. The annual weighted estimated survival rate (98.2%), success rate (96.6%), and complication rates in terms of ankylosis (2.0%), root resorption (2.9%), and pulp necrosis (3.3%) were analyzed. No firm conclusions could be drawn with respect to the prognostic factors due to insufficient evidence of high quality. Conclusion The survival and success rates of autotransplantation of teeth with incomplete root formation were high (> 95%), with a low rate of complications (<5%)