Incorporating Formative Assessments Into the Preclerkship Lecture

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Dedicated professionals—musicians, athletes, artists—constantly self-evaluate, ritualistically probing, targeting, and improving weaknesses before presentation of their work. Similarly, in clerkship rotations, medical student knowledge and skill are continually examined and improved through active problem solving and faculty-posed questions (“pimping”) before summative evaluations. In contrast, preclerkship course work has historically lacked such formal, daily tools for ongoing self-assessment and improvement before cumulative examination. For remedy, medical educators have increasingly recognized the value of student-centric learning, and several recent initiatives, such as the flipped classroom, problem-based learning, and team-based learning, have capitalized on the growing body of supportive pedagogical evidence. While we applaud these and other learner-oriented adaptations to preclerkship education, the primary mode of instruction generally remains didactic, with inquiry-based learning sequestered to occasional discrete activities. For continued improvement sans curricular overhaul, we suggest furnishing the lecturer-centric modality with diagnostic, educative, and reflective assessments antecedent, concomitant, and subsequent to classroom instruction. Such formative assessments might include prelecture reading quizzes; in-class polling; daily, weekly, and monthly postinstruction quizzes; and challenging extension questions.
Although most formal studies evaluating formative assessments are subject to methodological recrimination, education literature as a whole continues to showcase improved outcomes, particularly in concept understanding, application, and retention.1 Moreover, formative assessments can direct educators toward struggling individuals or reveal classwide misconceptions, and we informally find formative assessments highly favored among learners. Crucial for the preclerkship student, the provision of abundant, personalized, and real-time feedback encourages greater meta-awareness for more potent study. By varying context and presentation medium, formative assessments can also promote content mastery over apparent familiarity attained from rote rehearsal of lecture materials.
We reason that greater incorporation of formative assessments would provide improved scaffolding for preclerkship learning while still preserving conventional curricular architecture, easing the onus on faculty to engineer improvements. To counter student apprehension and accentuate learner benefit, these assessments could be graded with minimal weight or for completion. Ultimately, we call for increased integration of platforms in the lecture regime that support the continued development of problem-solving ability. By such inclusions, we believe that medical educators will be better equipped to instruct preclerkship students in large settings and consequently elevate testing outcomes, clerkship readiness, and the learner.
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