Optimizing Content Knowledge Acquisition: Use of Low Stakes Assessments to Promote Student Learning and Comprehension
Evidence relating the correlation of clinical confidence and knowledge retention suggests a positive relationship between knowledge (as demonstrated by evaluation performance) and confidence. Cognitive load theory suggests there is value in repeating low stakes assessment questions designed to develop studentsÕ confidence related to their content knowledge. Students who feel confident with content and perform well academically may perceive increased confidence managing patients in a future clinical setting. However, false or inappropriate confidence or self-awareness, coupled with a lack of content knowledge retention has the potential to challenge students and adversely impact clinical reasoning and further, decision making related to patient care. The purpose of this study was to determine if student self perception of confidence aligned with their content knowledge.
Participants included entry level physical therapist students (n=61), enrolled in the second session of their second year in an entry-level doctor of physical therapy program. Students were enrolled in a 10-week musculoskeletal course covering cervical and thoracic spine content. Repeated assessment questions designed to promote content knowledge learning and comprehension were delivered through the use of polling software (Poll Everywhere TM) in weeks 1, 2, 4, 6, and 8 during the lecture component of a 10 week course. Polling questions were presented in a multiple choice format, consisting of both questions on confidence and content knowledge. Confidence based questions consisted of a single question asking students to rate their confidence (on a 3 point likert scale 1 to 3; 1= disagree and 3= agree) on a content specific topic (eg. neck pain with mobility deficits). Confidence checks were presented both prior to and immediately after lecturing on the content specific topic. Content checks consisted of 4 knowledge based, summative questions, and were delivered at the conclusion of each lecture. Additionally, students completed a survey at the end of the 10 week session on their experience with the polling exercise (10 questions on a 5 point likert scale; 1=strongly agree and 5= strongly disagree) with the option to provide additional qualitative feedback in text box format. Students' responses were anonymous throughout the 10 week session and did not influence grade outcome.
Content and confidence based questions were sent to 61 participants pre and post delivery of content specific topics (musculoskeletal based) at 5 time points throughout a 10 week semester. Additionally a post course survey was sent to 61 participants at the end of the 10 weeks of content delivery. The response rate of the post course survey was 57/61(93%). Results of the survey were that 47% of participants reported coming prepared to class. Overall, participants found value in the polling exercise to test content knowledge (47% yes; 64% yes and neither agree or disagree) and 44% of participants found that the polling questions helped to determine areas of content to focus on (72% of participants answering yes and neither agree or disagree). Pooled qualitative comments from the post course survey revealed participants reported they did not feel confident answering the confidence checks, indicating they needed time to review the lecture content prior to answering a post confidence check on material. Additional qualitative comments on the content checks revealed some participants requested wanting increased number and higher challenge level content questions. Participant feedback also validated that poll based questions aligned with high-stakes exams and assessments.
Conclusions/Relevance to the conference theme:
Several studies relating the correlation of clinical confidence and knowledge retention found a positive relationship between knowledge (as demonstrated by evaluation performance) and confidence. Strategically placed, low stakes student assessments on content specific topics used the power of retrieval, or the testing effect, as a learning tool. Empirical evidence suggests practicing retrieval is a superior strategy for deep learning compared to re-exposure to the original material. Practicing retrieval as a teaching and learning tool not only contributes to deeper learning and knowledge retention of the student, but may prepare students for retrieving content knowledge based information in the clinical setting.