Archived case study

Interactive computer marked assessment (iCMA) simulating healthcare practice

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Innovation

Simulating healthcare practice for assessment – a case study approach to the development of interactive computer marked assessment (iCMA)

The Open University has developed iCMAs that mimic the reality of practice and enable students to demonstrate their knowledge, understanding and increasing analytical skills across increasingly complex service user scenarios without compromising service user safety. Each iCMA follows a service user’s psycho, social and physical life journey, moving between health, acute illness and long term health needs. The context of care moves between home, community and acute settings. The iCMAs also engage students with exploring interprofessional and inter-organisational working. Students are required to seek information from a variety of sources, such as patient records, medication packs etc., thus enabling them to engage with the complexities of practice. On completion of each iCMA question, within a suite of questions, students receive instant, high quality feedback encouraging them to build on their learning throughout the assignment.

What prompted innovation?

In 2002, Laurillard reminded us that too often ‘Traditional modes of assessment of knowledge are seen as inadequate because they fail to assess students’ capability in the authentic activities of their discipline.’

This is particularly pertinent when designing assessment for learning in complex professional situations, such as healthcare practitioners caring for service users and carers. Case studies, which give details of a person’s situation and their health condition, followed by a series of multiple choice questions that seek to assess students’ understanding of the person’s healthcare needs are often used in healthcare assessments, as it is known that clinical decisions are strongly influenced by context (Bucknall 2000). However, when students are in practice, information about people’s health does not come in a neat case study, but needs to be sought out from patient accounts, patient records, lab reports, x-rays etc.

The rise of eLearning technologies has led to increased opportunities for assessment and many eAssessment assignments in Higher Education use objective question types, in particular multiple choice (Slater 2007). However, these question types alone may be limited when assessing the application of learning in complex professional situations, such as making decisions regarding patients’ health. We have therefore taken an experiential approach to assessment, and developed interactive compute marked assignments (iCMAs) that mimic the reality of practice.

What makes innovation different?

These computer marked assignments mimic the complexity of practice and interprofessional working. Also, to improve the student experience and acknowledge students’ concerns across higher education that feedback is often poor or no longer timely, these iCMAs give instant, high quality feedback, in many instances tailored to the achievement of each individual.

These assignments also provide robust distance learning assessment as within the service users journeys each student receives a unique random selection of questions. These assignments are also used to follow student progress in numeracy throughout their pre-registration programme or foundation degree, so that students requiring extra support are identified in a timely manner.

Changes in practice

Having rehearsed skills through the iCMAs, students are gaining confidence in applying their knowledge and understanding when they go into practice. In addition, presenting numeracy within patient journeys and identifying students requiring extra support is highlighting the importance of developing competence in the application of numeracy.

We also use these iCMAs to keep students abreast of policy developments in a rapidly changing healthcare environment that impacts on their practice, such as updated NICE guidelines, to ensure their practice maintains currency.

Impact

The recent (2013) internal periodic programme review panel commended ‘The imaginative and robust use of interactive Computer Marked Assignments (iCMAs)’ and recommended that the learning design should ‘be disseminated more widely’.

Given the importance of numeracy in healthcare practice, the panel were also ‘pleased to see how the programme team have developed innovative approaches to developing and assessing numeracy skills from the outset including diagnostic tools’.

Dissemination

Workshops have been run for module production teams within the nursing department to facilitate their understanding of the challenges and rewards of assessing students in this way and to help them to develop such iCMAs themselves. Bespoke presentations of this approach have been given, internally, to colleagues in the Faculties of Science and Social Science, and more generally at university level. The intention is to present on this innovation at external conferences in the coming year.