Investigating the Effects of Exam Length on Performance and Cognitive Fatigue

This study examined the effects of exam length on student performance and cognitive fatigue in an undergraduate biology classroom. Exams tested higher order thinking skills. To test our hypothesis, we administered standard- and extended-length high-level exams to two populations of non-majors biology students. We gathered exam performance data between conditions as well as performance on the first and second half of exams within conditions. We showed that lengthier exams led to better performance on assessment items shared between conditions, possibly lending support to the spreading activation theory. It also led to greater performance on the final exam, lending support to the testing effect in creative problem solving. Lengthier exams did not result in lower performance due to fatiguing conditions, although students perceived subjective fatigue. Implications of these findings are discussed with respect to assessment practices.     

Student retention of course content is improved by collaborative-group testing

We recently reported that collaborative testing (i.e., group test taking) increased student performance on quizzes. It is unknown, however, whether collaborative testing improves student retention of course content. Therefore, this study was designed to test the hypotheses that collaborative-group testing improves student retention of course content. To test this hypothesis, our undergraduate exercise physiology class of 38 students was randomly divided into two groups: group A (n = 19) and group B (n = 19). During exam 1, students from both groups answered questions in the traditional format as individuals. Immediately after completing the exam as individuals, students from group A answered a randomly selected subset of questions from exam 1 in groups of two (1 group had 3 students) to test the effectiveness of collaborative-group testing on test performance and level of student retention. On the next exam (exam 2, 4 wk later), students from both groups answered questions in the traditional format as individuals and responded to the same subset of questions from exam 1. The subset of questions was analyzed to determine the level of retention of the original test material. In addition, immediately after completing the exam as individuals, students from group B answered a randomly selected subset of questions from exam 2 in groups of two (1 group had 3 students). Finally, on the next exam (exam 3, 4 wk later), students from both groups answered questions in the traditional format as individuals and responded to the same subset of questions from exam 2. This protocol followed a randomized crossover design to control for time and order effects. Student retention of course content was reduced when students completed the original examinations individually. In sharp contrast, student retention was improved (P < 0.05) when students completed the original examinations in groups. Results suggest that collaborative testing is an effective strategy to enhance learning and increase student retention of course content.     

Problem-based writing with peer review improves academic performance in physiology

The aim of this study was to determine whether problem-based writing with peer review (PW-PR) improves undergraduate student performance on physiology exams. Didactic lectures were replaced with assignments to give students practice explaining their reasoning while solving qualitative problems, thus transferring the responsibility for abstraction and generalization to the students. Performance on exam items about concepts taught using PW-PR was compared with performance on concepts taught using didactic lectures followed by group work. Calibrated Peer Review, a Web-delivered program, was used to collect student essays and to manage anonymous peer review after students "passed" three calibration peer reviews. Results show that the students had difficulty relating concepts. Relationship errors were categorized as (1) problems recognizing levels of organization, (2) problems with cause/effect, and (3) overgeneralizations. For example, some described cells as molecules; others thought that vesicles transport materials through the extracellular fluid. With PW-PR, class discussion was used to confront and resolve such difficulties. Both multiple-choice and essay exam results were better with PW-PR instead of lecture.     

The use of multiple tools for teaching medical biochemistry

In this work, we describe the use of several strategies employing the philosophies of active learning and problem-based learning (PBL) that may be used to improve the teaching of metabolic biochemistry to medical and nutritional undergraduate students. The main activities are as follows: 1) a seminar/poster system in a mini-congress format (using topics of applied biochemistry); 2) a true/false applied biochemistry exam (written by peer tutors); 3) a 9-h exam on metabolism (based in real publications); 4) the Advanced Biochemistry course (directed to peer tutors, where students learn how to read and criticize real medical papers); 5) experiments about nutrition and metabolism, using students as volunteers, and about free radicals (real science for students); 6) the BioBio blog (taking advantage of the "web age," this enhances out of class exchanges of information between the professor, students, and peer tutors); 7) student lectures on public health issues and metabolic disorders directed to the community and lay people; and 8) the BioBio quiz show. The main objective of these activities is to provide students with a more practical and interesting approach to biochemistry, such as the application of theoretical knowledge to real situations (diseases, experiments, media information, and scientific discoveries). In addition, we emphasize the importance of peer tutor activities for optimized learning of both students and peer tutors, the importance of a closer interaction between students and teaching staff, and the necessity to initiate students precociously in two broad fields of medical activity: "real" basic science and contact with the public (also helping students--future doctors and nutritionists--to be able to communicate with lay people). Most activities were evaluated by the students through written questionnaires and informal conversations, along various semesters, indicating good acceptance and approval of these methods. Good student scores in the biochemistry exams and seminars indicated that these activities are also working as valid educational tools.     

Having exams during Ramadan: The case of Indonesia

This paper studies the impact of fasting on students’ learning outcomes in the Indonesian context, the world’s largest Muslim country. Precisely, we measure the effects of Ramadan fasting by using a simple 2 × 2 difference-in-differences setting, exploiting the fact that, in 2018 and 2019, the Ramadan period coincided with the final exam periods in Universitas Indonesia. Our study uses Universitas Indonesia’s comprehensive student database (SIAK-NG), which provides detailed test scores, student-level, and course-level characteristics, and details on test schedules. It allows us to investigate Ramadan fasting’s direct effects, differential effects (whether morning and afternoon test effects vary or not), and cumulative effects (whether or not effects vary over time). We find no evidence of Ramadan’s negative effects on students’ test scores after controlling for semester-course-class fixed effects, student, class, and course characteristics. Consistently, we also find no evidence of morning-afternoon differential effects. We argue that the absence of (or weak) Ramadan’s effects is likely because Muslim students had adapted to the fasting environment earlier in the Ramadan period, allowing them to improve their scores as the exam period progresses. The regression results also suggest that the fasting effects are more positive among students with less good academic performance.     

Ways of coping as predictors of satisfaction with curriculum and academic success in medical school

The purpose of the present study was to determine the coping strategies of medical students and to investigate the effects of coping strategies on student satisfaction and academic achievement with different instruction methods. A total of 152 medical students was followed throughout the first 2 yr of medical education between 2008 and 2010. Students completed a sociodemographic questionnaire and revised form of the Ways of Coping questionnaire both at the beginning of the first year and at the end of the second year. These forms provided data about the characteristics and main coping strategies (problem focused or emotion focused) of the students and revealed the change over time. At the end of the second year, participants also completed a satisfaction questionnaire asking their satisfaction with lectures, problem-based learning, and practicals. The authors used block, problem-based learning, and practical exam scores of the students attained in the past 2 yr as academic achievement indicators. No sociodemographic variable was related to coping strategy. The majority of students (80.9%) adopted problem-focused coping. A shift occurred in the main coping strategies of some students in both sides. Problem-focused coping scores decreased over time. Problem-focused coping positively correlated with satisfaction with practicals and practical exam scores, whereas emotion-focused coping showed the same correlation negatively. The main coping strategy also predicted satisfaction and exam success in practicals. In conclusion, a main coping strategy may be helpful to predict student satisfaction and academic achievement with some student-centered instruction methods. Determining undesired coping strategies may provide an opportunity for intervention to prevent relevant dissatisfaction and failure.     

Interactive Evolution Modules Promote Conceptual Change

We developed a suite of online modules () to improve student understanding of challenging concepts in our introductory biology course at the University of Wisconsin-Madison. Here we assess the effectiveness of two of the modules, Species and Speciation and Natural Selection. In Year 1, unannounced pre-tests and post-tests were used to assess students’ prior knowledge and any gains resulting from lecture attendance alone. Then to test the effectiveness of the modules we divided the class into three groups. Group 1 was assigned the interactive speciation module and their analysis of the final case study in the module was graded. Groups 2 and 3 were controls. In Group 1, the subgroup of students whose mean scores on the first two exams in the course were <80% scored an average of 10.5 percentage points better on exam 3, a significant improvement. In contrast, none of the other student groups showed significant improvements in their grades. In Year 2, we tested the effectiveness of the online modules when offered as optional, ungraded, activities. We again saw significant improvement (+3.8 percentage points) only in those students who completed the modules and whose averages on the previous two exams were <80%. The differences in improvement between years 1 and 2 suggest that it is not enough simply to provide students with tools that help them learn; they also need an incentive in the form of a grade or course credit to use the tools most effectively.     

Clinically oriented physiology teaching: strategy for developing critical-thinking skills in undergraduate medical students

Medicine is an applied science, interpreting evidence and applying it to real life by using clinical reasoning skills and experience. COPT (clinically oriented physiology teaching) was incorporated in physiology instruction aiming to relate the study of physiology to real-life problems, to generate enthusiasm and motivation for learning, and to demonstrate the vocational relevance of physiology among students by integrating clinical experience with teaching. COPT consisted of two elements: 1) critical-thinking questions (CTQ) and 2) clinical case studies. After a few topics were taught, CTQ and case studies were given as an assignment. Answers were discussed in the next class. Two exams, each of which contained CTQ and recall questions, were conducted, one before (exam 1) and one after (exam 2) the implementation of COPT. Analysis of student performance in the examinations revealed that the students did better in exam 2 (P < 0.0001). Feedback from students indicated that this method was useful and challenging.     

Improving Education in Medical Statistics: Implementing a Blended Learning Model in the Existing Curriculum

Background

Although recent studies report on the benefits of blended learning in improving medical student education, there is still no empirical evidence on the relative effectiveness of blended over traditional learning approaches in medical statistics. We implemented blended along with on-site (i.e. face-to-face) learning to further assess the potential value of web-based learning in medical statistics.

Methods

This was a prospective study conducted with third year medical undergraduate students attending the Faculty of Medicine, University of Belgrade, who passed (440 of 545) the final exam of the obligatory introductory statistics course during 2013–14. Student statistics achievements were stratified based on the two methods of education delivery: blended learning and on-site learning. Blended learning included a combination of face-to-face and distance learning methodologies integrated into a single course.

Results

Mean exam scores for the blended learning student group were higher than for the on-site student group for both final statistics score (89.36±6.60 vs. 86.06±8.48; p = 0.001) and knowledge test score (7.88±1.30 vs. 7.51±1.36; p = 0.023) with a medium effect size. There were no differences in sex or study duration between the groups. Current grade point average (GPA) was higher in the blended group. In a multivariable regression model, current GPA and knowledge test scores were associated with the final statistics score after adjusting for study duration and learning modality (p<0.001).

Conclusion

This study provides empirical evidence to support educator decisions to implement different learning environments for teaching medical statistics to undergraduate medical students. Blended and on-site training formats led to similar knowledge acquisition; however, students with higher GPA preferred the technology assisted learning format. Implementation of blended learning approaches can be considered an attractive, cost-effective, and efficient alternative to traditional classroom training in medical statistics.     

The positive impact of team-based virtual microscopy on student learning in physiology and histology

Team-based virtual microscopy and on-line learning were used to transform the first-year Physiology/Histology course at The Johns Hopkins School of Medicine into a student-centered learning environment. Prior to each laboratory session, students were required to view prelaboratory virtual lectures and examine digital slides that had been enhanced with annotations and 2-min microlectures. The laboratory classroom was then used for team-based learning exercises including student presentations and small-group discussions designed to integrate histology and physiology. The results of quantitative assessments indicated an 8- to 14-point increase over the identical final exams given over the past 5 yr. Means (+/-SD) of percent correct answers on the final exam were found to be 75.2% (11.1%), 72.5% (12.6%), 70.5% (12.6%), 73.6% (11.3%), 73.1% (12.2%), and 84.1% (9.1%) for years 2001-2006, respectively. The mean test scores for all other years were statistically lower compared with 2006, as determined by the Bonferroni post hoc multiple-comparison test (P < 0.001 for all years).     

Human clay models versus cat dissection: how the similarity between the classroom and the exam affects student performance

This study examined the effect of different anatomic representations on student learning in a human anatomy class studying the muscular system. Specifically, we examined the efficacy of using dissected cats (with and without handouts) compared with clay sculpting of human structures. Ten undergraduate laboratory sections were assigned to three treatment groups: cat dissection only, cat dissection with handouts, and human clay sculpting with handouts. Exams included higher-order questions that presented novel anatomic images and scenarios that the students did not practice in class. The higher-order anatomy exam questions varied the degree to which students in the different treatments had to transform the anatomic representation studied during laboratory activities to match the representation used in the exam questions. In this respect, exam questions manipulated the similarity between the surface features of the anatomic representations used in the classroom versus the exam. When identifying anatomic structures presented in a photograph or diagram, student performance improved significantly when transformation demands decreased, i.e., students in the human clay sculpting treatment group performed best on human anatomy questions and students in the cat dissection treatment group performed better on cat anatomy questions (independent of the use of handouts). There were similar, but nonsignificant, trends when students were asked functional anatomy questions presented in human and cat contexts. On survey questions designed to measure student attitudes about dissection versus nonanimal alternatives, students typically preferred the method used in their treatment group, suggesting that student preference is too fluid to factor into curricular decisions. When designing curricula, instructors must choose anatomic representations that support their course goals. Human representations are most effective when teaching the human muscular system.     

Active review sessions can advance student learning

Traditional review sessions are intended to help students learn and prepare for upcoming exams. Most sessions are passive question and answer sessions that look backward at content deficits rather than advancing student learning. By incorporating active and cooperative learning approaches during a review session, students are able to recognize critical concepts and better prepare for physiological problem solving. Active review sessions help students prioritize the knowledge and develop the thinking skills will be required of them on the exam.     

Scent attractiveness and endocrine status in male students before and during a stress situation

Scent attractiveness of sweat samples collected from male students before and during theoretical exams was assessed by female students. Five-rank scale was used for subjective assessment of the scent samples in term unpleasant/pleasant. Scent attractiveness depended on physiological conditions of both recipients and donors. Male students with low basal concentration of salivary cortisol smelt better than students with high level of cortisol. High level of salivary testosterone also was associated with low scent attractiveness of the male students, but only for the recipients in non-receptive phase of menstrual cycle. In all, the females who were in receptive phase of menstrual cycle assessed scent attractiveness of male students higher then the females in non-receptive phase. Exam stress coincided with increase of the salivary cortisol resulting in decline of scent attractiveness in male students. The negative effect of exam was most prominent in students that failed exam and in student who aspired to be the best but failed. So, the exam stress and basal variation of stress-related physiological indexes, such as salivary cortisol, are mirrored in male chemical signals, which are recognized by females.     

Evidence that the apolipoprotein E-genotype effects on lipid levels can change with age in males: a longitudinal analysis.

We previously reported that change, with age, in plasma levels of total cholesterol (TC) and LDL cholesterol (LDL-C) differed between apolipoprotein E (APOE) genotypes epsilon 3 epsilon 3 and epsilon 3 epsilon 4, in a sample of 77 older, unrelated males. By use of a larger sample from that cohort, followed longitudinally during 1969-87, the change in TC and in LDL-C, between the epsilon 3 epsilon 3 and epsilon 3 epsilon 4 APOE genotypes, over three exams, was reanalyzed. Additionally, the change in triglycerides (TG) and in HDL-cholesterol (HDL-C), between the epsilon 3 epsilon 3 and epsilon 3 epsilon 4 APOE genotypes-as well as the differences between the epsilon 3 epsilon 3 and epsilon 3 epsilon 2 genotypes, for TC, LDL-C, TG, and HDL-C-were contrasted over the three exams. At exam 1 TG was higher in the epsilon 3 epsilon 4 group than in the epsilon 3 epsilon 3 group (mean age 48 years), and at exams 2 and exam 3 (mean ages 58 and 63 years, respectively) it was similar (P = .009 for the exam-by-genotype-interaction effect in the repeated-measures analysis). A similar trend was seen for TC (P = .03), yet previously detected LDL-C effects were not apparent (P = .46). Those with the epsilon 3 epsilon 2 genotype had higher TG and lower LDL-C and TC at each exam than were seen in those with the epsilon 3 epsilon 3 genotype, although the differences in the values were not always statistically significant. Differences in TC, LDL-C, and TG, between the epsilon 3 epsilon 2-genotype and epsilon 3 epsilon 3-genotype groups, did not significantly change over the three exams. HDL-C levels were relatively stable over the exams; however, the exam-by-genotype interaction was significant for the epsilon 3 epsilon 2 genotype versus the epsilon 3 epsilon 3 genotype (P = .02). The epsilon 4 allele effects on TG and TC changed between longitudinal exams and may be age dependent. Changes, with age, in the effect of the epsilon 3 epsilon 4 genotype on lipids may impact the risk of developing atherosclerotic disease.     

Beliefs Matter: Cultural Beliefs and the Use of Cervical Cancer-Screening Tests

In this article we examine the influence of cultural beliefs on behavior or, more specifically, beliefs about cervical cancer risk factors and the use of Pap exams. Individual Latinas' (Hispanic women) holding of beliefs similar to Latinas' generally (cultural consonance) did not significantly influence their use of Pap exams. Rather, structural factors such as medical insurance, age, marital status, education, and language acculturation explained Latinas' use of this medical service. However, when Latinas held beliefs similar to those of Anglo women, then they were significantly more likely to have had a Pap exam within the past two years. Latinas whose beliefs were closer to those of physicians were significantly less likely to have had the exam recently. Arriving at these findings involved both ethnographic interviews and survey research. That these beliefs proved to be significant influences on behavior suggests not only the important ways that beliefs matter but that ethnographic methods for examining those beliefs also matter. [ Latinas and cervical cancer, Pap exams, culture and behavior, ethnography and survey research ]     

Interobserver reliability of methods for paleopathological diagnosis of dental caries

There is disagreement as to whether clinical methods of caries diagnosis will produce reliable results in skeletal material, and studies vary greatly in the extent to which such methods are employed. The purpose of this study is, therefore, to evaluate the interobserver reliability of visual, tactile, and radiographic methods of scoring dental caries in ancient populations. Thirty-three individuals from a Mogollon skeletal sample were scored on three occasions by pairs of examiners. The first exam employed visual criteria alone. In the second exam, visual methods were supplemented with the dental explorer. For the third exam, mesial and distal surfaces were scored from “intraoral” radiographs. Examiners worked independently, but did calibrate on material from clinical populations prior to the second and third exams. Exams were conducted on a “blind” basis, and analysis was delayed until all exams were completed. Caries scores were expressed as a percentage of total surfaces present per individual. Repeat-measures ANOVA and intraclass correlation coefficients (ICC) were used to estimate interobserver reliabilities. For visual scores, ICC = 0.97, and there is no significant difference between examiners (P = 0.897). For visual plus explorer scores, ICC drops to 0.90, and there is a significant difference between examiners (P = 0.003). For the radiographs, ICC = 0.86, and there is no significant difference between observers (P = 0.117). These results suggest that clinical methods are less reliable in skeletal populations. Probable sources of error include postmortem dehydration of carious dentin, confusing radiolucencies engendered by worn or fractured enamel, and inadequate radiologic standards for root caries. These problems can be avoided through reliance on visual criteria.     

Use of Galvanic Skin Responses,Salivary Biomarkers,and Self-reports to Assess Undergraduate Student Performance During a Laboratory Exam Activity

Typically, self-reports are used in educational research to assess student response and performance to a classroom activity. Yet, addition of biological and physiological measures such as salivary biomarkers and galvanic skin responses are rarely included, limiting the wealth of information that can be obtained to better understand student performance. A laboratory protocol to study undergraduate students'' responses to classroom events (e.g., exams) is presented. Participants were asked to complete a representative exam for their degree. Before and after the laboratory exam session, students completed an academic achievement emotions self-report and an interview that paralleled these questions when participants wore a galvanic skin sensor and salivary biomarkers were collected. Data collected from the three methods resulted in greater depth of information about students'' performance when compared to the self-report. The work can expand educational research capabilities through more comprehensive methods for obtaining nearer to real-time student responses to an examination activity.