Student project cases: a learner-centred team activity broadly integrated across the undergraduate medical curriculum

Abstract

Background: Student Project Cases (SPCs) in the Monash University medical curriculum comprise a teamwork activity that emphasises interdisciplinary learning. SPCs provide a learning program contextualized within the broader medical curriculum, in which students research and present a medical disease. SPCs were introduced into the medical curriculum to integrate more active learning by creating a learning environment which: actively engages students in the learning process and encourages deep approaches to learning, promotes self-directed learning, develops the ability to work in teams, builds information gathering and processing skills, and develops presentation skills.

Methods: The design of the SPCs requires students to: make decisions regarding the overall organisation of their group and presentations, communicate and work as members of small groups, research, identify, critically analyse, synthesize and integrate information, and prepare and communicate via written and oral presentations. To ensure effective and consistent assessment practices, an extensive series of simple and effective proformas were developed, including components of peer, self and staff assessment. Assessors utilise objective observations of student performance or achievement; numerical marks are independently based on specific descriptors aligned with learning objectives. The effectiveness of SPCs was evaluated through questionnaires, focus groups and informal feedback, involving both students and staff.

Conclusion: The assessment proformas were successful learning aids for the students and allowed staff to critique student performance in a non-subjective manner. The SPCs are a successful active learning program which engages students and encourages deep learning and could readily be adapted by a diverse range of courses. The SPCs also develop graduate attributes of life-long learning skills including: capacity for inquiry and research, critical thought and analysis, problem solving, teamwork and written and oral communication. Additional benefits encompass enhanced student appreciation of learning and assessment as well as development of confidence in addressing new or complex tasks.

Introduction

University teaching has, in recent years become much more directed towards active student learning. To be active learners, students must be active participants in their learning: they must read, write, discuss or be engaged in solving problems and they must engage in higher order thinking tasks such as analysis, synthesis and evaluation (Bonwell & Eison 1991; Chickering & Gamson 1987). S tudents involved in learner-centred active learning are more likely to achieve meaningful learning than students who are passive participants in the learning process (Kraft 1985; Stice 1987; Barr & Tagg 1995; Michael 2001, 2006; Novak 2002). Learner-centred approaches are also reported to encourage deeper approaches to learning (Ramsden 1992 & Biggs 1999), associated with improved learning outcomes (Biggs 1987; Prosser & Trigwell 1999; Zeegers 2001). Active learning modalities are now used extensively in medical curricula. Problem-based learning and case-based learning are used extensively for such purposes.

The use of more varied learning activities which are active and student-centred requires appropriate assessment methods. Attention should be given to the goals of the assessment, what is to be assessed and how assessment is performed. Issues concerning the role and methods of assessment used in higher education include: the importance of assessment in guiding student learning, assessment of higher order thinking processes and the development of generic skills including teamwork, communication, critical analysis and problem solving (Isaacs 2002; James et al. 2002; Shumway & Harden 2003; Cottrell 2006).

Table

Practice points
•Student Project Cases provide an activity which engages students as active learners and encourages the development of higher order learning skills.
•Students value transparent assessment criteria and use these when preparing their submissions.
•Assessment utilising objective observations of student performance based on explicit criteria allows reliable information to be generated by staff, peers and students themselves.
•Final marks incorporate group and individual contributions.
•Student project cases permit creative presentation opportunities for students.

Many of the active learning approaches which have been introduced into Universities involve group work and this has become an important component of many undergraduate medical courses. Collaborative group work is widely accepted as an effective learning method which can improve students skills’ in: understanding teamwork, leadership, communication, organisation and time management. Assessment of group work is now a regular component of students’ final grades but this has some potentially troubling aspects. For example, one of the major concerns of students is that the assessment may not fairly assess the contributions of individuals (personal communications). Other issues which must be addressed include: whether the process or outcome is assessed, the nature of the assessors (staff, peers or self) and the assignment of marks according to achievements of the group as a whole or of individuals therein.

Finally, the breadth of the components of the learner-centred activity in terms of links to various curricular emphases and the depth of penetration by students into detail of specific topics are aspects that should be balanced for optimal utility.

Background/context

The current Monash University medical curriculum provides an interdisciplinary program, organised as an integrated structure incorporating four themes (I: Personal and Professional Development; II: Population, Society, Health and Illness, III; Foundations of Medicine and IV; Clinical Skills). It presents a continually expanding level of medical experience, starting in the first semester of the course. In years one and two, the basic medical sciences are taught by staff from a range of departments across the faculty, in an interdisciplinary fashion largely driven by emphasis on links between the basic sciences and patient care. The Monash medical curriculum is a blended learning approach (Aycock et al. 2002; Garnham & Kaleta 2002; Shaffer & Small 2004; Pereira et al. 2007) whose goals are to bring together large group teaching, self-directed learning and small group work in combinations which are aimed at enhancement of student learning. The multiple modalities for medical education, which blended learning and its associated teaching styles provide, have strong potential to cater for the different learning styles (Kolb 1984) of our students.

Monash medical students participate in more than 30 case presentations (Patient Centred Learning activities) over years one and two of the course, using material prepared by academic staff. Student Project Cases (SPCs) are an innovative component of student learning in year two of the medical curriculum, in which each student actually plans, develops and presents a medical case or disease scenario, in a self-directed learning manner involving a team of three or four students. This novel approach to learning makes the presentation of the cases the responsibility of the students themselves, within a set of guidelines common to each case, and a series of pointers specific to each of the topics.

SPCs were introduced into the medical curriculum with the following objectives: to integrate more active learning by creating a learning environment which actively engaged the students in the learning process and encouraged deep approaches to learning, to promote student self-directed learning, to develop the ability to work in teams, to build information gathering and processing skills linked to organisation of knowledge and to develop presentation skills. Topics were chosen, which: we considered would stimulate students’ interest, were related to previous or current curriculum content and allowed students to delve thoroughly into the topic and thereby achieve deep learning. The SPCs require the students to actively research a topic (within specified limits), identify resources, evaluate the material, discuss issues and problems with peers and staff, synthesise the researched material into an integrated written summary and produce an oral presentation in which they all participate. These active learning strategies are encompassed in the learning objectives as follows.

On completion of the Student Project Cases, students should be able to:

1. integrate information from the four curriculum themes;

2. integrate and synthesise information from different body systems and human perspectives in the appreciation of clinical issues;

3. identify relevant resources and critically analyse information from a variety of sources;

4. work effectively and communicate constructively within small groups in the planning, development and implementation of teamwork tasks, with individual and group responsibilities and adherence to project timelines;

5. discuss issues and problems in a structured manner and act as spokesperson for a group in a wider forum;

6. apply skills in audiovisual presentations on particular topics in medicine;

7. develop skills in preparation of written summaries in the form of notes suitable for effective communication and education;

8. apply constructive critiques to verbal and written presentations;

This paper describes the SPC integrated learning activity and discuses the implementation and evaluation of active learning, teamwork, the embedded assessment practices and student perceptions, both relating to the process and outcome.

SPC process

All second year medical students (approximately 300) are required to participate in the SPC process. According to the present structure, there are six different topics; three are made available in each semester. In each semester half the class work throughout the semester, in small groups, to research and prepare both written and oral presentations on their single assigned SPC topic culminating in oral presentations in the final week of semester. The other half of the class during that particular semester only participate as active members of the audience during the presentations in the final week. In the second semester students change roles from presenters to audience, and vice versa. Hence, on completion of the year all students will have participated as both the researchers/presenters and audience members. In this structure, over the course of the academic year each student will have researched one topic (as part of a small team) and attended presentations on all other five topics.

A pool of SPC topics and guidelines were developed which are rotated in different years. New topics are developed each year to increase the pool and all topics are reviewed regularly for relevance to the course and currency of information provided.

A. Preliminary organisation

The SPC process commences with a student briefing session detailing the SPC process, organisation, requirements and assessment. Students are required to work in small groups (3–4 students) which they can self select. The SPC briefing session also covers issues of group makeup and dynamics to facilitate group selection. Students receive an extensive studyguide which includes: learning objectives of the SPCs, project requirements, deadlines, all assessment forms used by staff, peers and students, specific topic guidelines and an exemplar for a similar topic to that which students would undertake (but not one which is specifically set for students). The specific topic guidelines recommend the scope and depth of the SPC topic, define the core material (content to cover in both the written and oral presentations), provide pointers to particular topics in the various semester themes relevant to that SPC and give starting references (Table 1).

Table 1.  Example of specific topic guidelines for SPC on diabetes mellitus type 2 and metabolic syndrome

Core Material for SPC: Diabetes Mellitus Type 2 and Metabolic Syndrome
All of the topics listed below must be included in the presentation of the SPC and in the Written SPC Topic Summary. You can however emphasise some more than others. The core material will be listed under the Themes upon which your course is designed but, as it is important that the SPC present the material in an integrated manner, many of the topics are listed under more than one theme as they integrate across a number of themes.
Theme 1: Personal and Professional Development
Theme 2: Population, Society, Health and Disease
Theme 3: Foundations of Medicine
Theme 4: Clinical Skills
Scope and Depth
In preparing this SPC students should concentrate on diabetes mellitus type 2 (due to insulin resistance) and metabolic syndrome. It may make mention of other types and causes of diabetes but should not provide details regarding these. Furthermore, care should be taken not to digress excessively into discussion of obesity and lipid disorders outside the context of diabetes mellitus Type 2 and metabolic syndrome.
Topic
1.  Classification of diabetes including Type 2 diabetes
2. Signs and Symptoms of Type 2 diabetes
3. Diagnostic criteria
4. Definition/criteria (in relation to Type 2 diabetes) of:
• obesity (central versus peripheral)
• lipid disorders
• hypertension
5. Definition and criteria of Metabolic Syndrome
6. Epidemiology of Type 2 diabetes (including childhood & adolescence and ethnicity)
7. Pathogenesis of Type 2 diabetes (genes versus the environment)
8. Complications of Type 2 diabetes
9. Treatment of Type 2 diabetes:
10. Prevention of Type 2 diabetes
11. Public health significance of Type 2 diabetes and obesity
12. Health promotion, lifestyle and behavior change
13. Implications for self care
References
The references given below are starting references. You will need to research your SPC topic extensively and use many more references than this to provide a comprehensive and integrated presentation. A detailed Bibliography must be included in the Written SPC Topic Summary that you submit.
Kumar P, Clark M. (2002), Clinical Medicine, 5th ed, W.B. Saunders, UK
World Health Organization. Definition, Diagnosis and Classification of Diabetes mellitus and its Complications; Part 1: Diagnosis and Classification of Diabetes Mellitus. (Department of Noncommunicable Disease Surveillance, Geneva 1999).
http://www.who.int/ncd/dia/dia_publications.htm#WHO PUBLICATIONS

B. Preparation phase

The SPC activities encompass the entire semester (14 weeks) with a number of deadlines distributed throughout. The preparation phase involves students in the following sequential activities: organisation and management of groups, researching and analysing of material, integration across key learning areas, preparation of a written summary and organisation and preparation of the final oral presentation. Student groups are required to attend four meetings with a Staff Advisor over the course of the semester, at which are discussed SPC requirements, group management, research, resources and the presentations (oral and written). The timetable of activities, including student requirements and assessment details, is shown in Table 2. Advisor meetings allow students to test and develop their understanding of the topics and provide a venue for informal, formative feedback. At each meeting Advisors complete assessment forms which are related particularly to communication skills, group work and time management.

Table 2.  Timetable of SPC activities

Week	ACTIVITY (and relevant Assessment Form)
1	BRIEFING ON THE SPC PROGRAM
	Introduction to SPCs. Details of SPC process, allocation of groups, SPC Topics
2	Meeting 1 with Staff Advisor
	Preliminary discussion.
	Students must have met and discussed topic and core material to be covered before attending.
	(Assessment form AD-1(Advisor))
4	Meeting 2 with Staff Advisor
	Submission of Management Flow Chart which will constitute a “contract” between students and is to be signed by each student in the Presenting Group and countersigned by the Staff Advisor. Management Flow Chart should include responsibilities for written summary.
	List sources of information for written summary.
	Discuss progress and possible oral presentation formats.
	(Assessment form AD-2(Advisor) and Management Flow Chart agreement form M-1)
9	Meeting 3 with Staff Advisor
	Submission of Written Summary (hard copy and electronic to Advisor). This will be returned before meeting 4 with assessment and feedback.
	Discuss oral presentation format.
	(Assessment form AD-3(Advisor))
12	Meeting 4 with Staff Advisor
	Feedback/discussion of Written Summary. Students should have read Advisors feedback comments before meeting.
	Details of oral presentation (including role of individual students) to be presented to and discussed with Advisor.
	Submission of 2 example questions (hard copy and electronic to Advisor).
	(Assessment forms AD-4(Advisor), P-1(Peer), S-1(Self))
13	Deadline for Written summaries to be loaded on WebCT- vista
14	SPC presentations either as a member of a Presenting Group or Audience.
	(Assessment forms F-1(Facilitator), F-2(Facilitator), P-2(Peer))

To assist the students with the development of management skills of planning and adherence to timelines they are required to draw up a management flow chart. This requires explicit indication of the specific responsibilities of individual students within the group, relating to acquisition and processing of content and preparation of material for both the oral presentation and written submission. This constitutes a contract between students and is to be signed by each student in a presentation group and countersigned by the Staff Advisor.

C. SPC written summaries

Groups research and write summaries (2000–3000 words) which require: the integration of information from different body systems and human perspectives in the appreciation of clinical issues, the provision of explicit links between biomedical science and clinical medicine. All four curriculum themes which cover broad aspects of medical learning (see above) must be incorporated in the summaries which are submitted in Weeks 8 or 9 to Staff Advisors and are assessed then returned to the students. Extensive feedback is also provided to students, by way of both written comments and personal discussion, prior to the oral presentation. These edited written summaries are made available to all students in the year level through the unit website.

D. SPC oral presentations

In the final week of semester a Presentation Day is organised in which each group gives a 30-minute oral presentation. The presentations are permitted in any suitable mode according to student preferences. Thus they have included: conventional seminar/lecture presentations, panel discussions or round table commentaries, role-playing (e.g. simulation interview with “experts” and patient-doctor simulations) or even judiciously chosen mixtures of presentation formats. At these sessions the presenters are teaching their peers, each of whom will have researched a different topic from that being presented. A Staff Facilitator is assigned to each session to organize the session, facilitate discussion and assess the presentations. To ensure that students forming the audience groups are actively involved in the learning process there are three phases to each topic presented.

Phase A: Student presentation

The Presenting groups give their presentations in the mode of their choice, thus providing delivery of an educational experience to the audience by their peers.

Phase B: Student questions and discussion

The audience is divided into Response groups with each such group required: to discuss the presentation, phrase two substantive questions to be posed to the presenters, and complete peer assessment forms. While the Response groups are in discussion, the Facilitators provide feedback to the presenting group.

Phase C: Problem solving session

The Staff Facilitator provides a Problem or Issue Topic sheet to be considered by each of the Response groups. A member of the Presenting group for that specific topic (the “student content expert” for that topic) acts as a student resource person to facilitate each Response group's discussion in preparing satisfactory answers to the problems or making informed comment on the issue topic. The entire group then reconvenes and each Response group presents a set of responses to a designated aspect of the problem or issue topic. Discussion amongst the entire roomful of students then follows.

Results and discussion

Evaluation

At the completion of the SPCs students were asked voluntarily and anonymously to complete a hard copy questionnaire which contained both closed and open-ended questions. The response rate was 96% and the data from the questionnaires were analysed to investigate the students’ perceptions of the SPCs and to examine the extent to which student-centred outcomes of the SPCs were aligned with the stated learning objectives. Staff Advisors and Facilitators also completed questionnaires. Finally, the evaluation process also considered student results in the various assessments.

Student learning

Student questionnaires incorporated questions to determine if students had developed higher order learning skills, such as integration, evaluation, interpretation and synthesis. The data in Table 3 shows that 88% of students integrated material from at least two themes, 86% addressed information and issues that encompass both biomedical and clinical medicine, 79% felt they were required to make judgments regarding the validity of information at least half of the time and 84% used interpretive skills at least half of the time in the preparation of the SPCs. These student responses confirm that, in order to participate in the SPCs, students were required to be active in the learning process and to use higher order learning skills.

Table 3.  Student responses to questions related to active learning in SPCs. Data are expressed as the percentage of students replying (147 students)

	Theme 3 exclusively	Mainly theme 3	Integrated 2 themes	Integrated 3 themes	Integrated all 4 themes
The SPC topics were based on the Theme III* content in year 2 of your MBBS course. In preparing your SPC did you integrate material from other themes?	3	9	22	16	50
	Hardly ever	Occasionally	About half the time	Much of the time	almost always
Preparation of the SPC required me to address information and issues that encompass both biomedical science and clinical medicine. This applied to me:	1	13	25	46	15
Preparation of the SPC required me to make judgements regarding the validity of the information I used. This applied to me:	3	18	19	40	20
Preparation of the SPC required me to use/develop interpretive skills. This applied to me:	6	10	29	41	14
	Did not improve at all	Improved slightly	Improved significantly	Improved to a great extent	Improved enormously
As a result of having to write a summary of the topic my skills in distilling complex bodies of information into a concise form, easy to digest by other people:	5	29	41	19	10

*As described in the text.

Concerning students who were in groups preparing SPCs, 67% reported “I found myself wanting to learn more about, or to develop further ideas relating to the topic I researched”. Of those in the audience for the oral presentations, 80% reported “I found myself wanting to learn more about the presented topics or to develop further ideas relating to them”. These data show that the SPCs succeeded in both engaging the students in the learning experience and in stimulating their interest in the curriculum content.

In general, the SPCs are a guided self-directed learning activity which requires students participating to be active in the learning process. In order for students to perform well in the SPCs, one would expect them to be each individually involved in self-directed learning. However, as the SPCs are a group activity there could be instances where other members of the group directed the work. This factor is satisfactorily accommodated by a peer assessment component, as discussed below.

Assessment

Assessment has been designed as an integral component of the SPCs with the goals of motivating students and the attainment of the learning objectives. We aimed to assess deep approaches to learning and higher order thinking processes (Chickering & Gamson 1987; Bonwell & Eison 1991; Ramsden 1992; Biggs 1999) by assessing skills such as analysis, synthesis and integration and generic skills such as communication. Students are assessed during all phases of the SPC process with the preparation phase, written summary and oral presentation contributing to the overall mark (Table 4). The assessment is performed by Advisors, Facilitators and students (self and peer) and consists of both group and individual components. When the SPCs were initially introduced, the weighting of peer:staff assessment was 60:40. However, as the average mark given by peer assessment was 94% the weighting was changed to the current 20:80 balance. We retained the peer component of the assessment because, although the average peer assessment mark was consistently very high, the marks given have ranged from 15% to 100% providing wide spread. In groups where particular members were evidently not contributing equally, low scores have been received from the peers within the presentation group. The inclusion of the peer assessment thus allows an assessment of the contribution of individuals to the group work. The relative contributions of group and individual marks to the student's final mark comprise group mark (70%) and individual mark (30%).

Table 4.  Contribution of assessment items to final mark

Form	Assessor	Activity	Weighting %
AD1-4	Staff Advisor	Preparation phase Participation, contribution, teamwork, organisation	–
AD-W	Staff Advisor	Written summary: Content, balance, flow, clarity, presentation	40
P1	Peers (within presentation team)	Preparation phase: Participation, contribution, teamwork, organisation	10
S1	Self (student)	Preparation phase Participation, contribution, teamwork, organisation	–
F1	Staff Facilitator	Oral presentation (group mark) Content, integration, balance, flow, quality	20
F2	Staff Facilitator	Oral presentation (individual mark) Content, delivery	20
P2	Peers (audience at oral presentation)	Oral presentation (group mark) Content, integration, balance, flow, quality	10

To ensure effective assessment practices and consistent assessment of the SPCs an extensive series of simple and effective proformas have been developed which align the assessment criteria directly with the learning objectives. Assessors utilise objective observations of student performance or actions based on specific descriptors aligned with the learning objectives. The use of subjective impressions has been marginalised or eliminated by the requirement for assessors to tick appropriate boxes and the avoidance of subjective assessment using vague adjectives such as “good” or “poor”. Numerical marks are derived later according to “look-up tables”. Table 5 is the assessment form used by Staff Advisors assessing the 2000–3000 word group written summary. This form is returned to the students and discussed at the final meeting with the Advisors. Table 6 is an example of an assessment form used by Facilitators assessing an oral presentation. Similar assessment forms are used for other aspects of peer and self assessment, each tailored to the relevant criteria and assessor types. Responses concerning the use of these forms by Staff assessors has been very positive, with the majority of comments indicating that aligning the appropriate descriptor with a student activity is a more affective assessment method than the designation of a numerical score.

Table 5.  Advisor assessment form AD-W

This Form is for the assessment of the written summary and is completed by the Staff Advisor.
• Accuracy of subject/content	Very accurate	A few minor errors	At least one major error a number of minor inaccuracies	Many inaccuracies	Unacceptable number of inaccuracies
• Coverage and balance of topics	All topics covered	One topic omitted	2-3 topics not covered	4-6 topics not covered	Very few topics covered (<4)
• Detail of topics	All topics covered in appropriate detail	Only one topic not covered in appropriate level of detail	At least 2 topics not covered in appropriate level of detail	Many (3-6) topics not detailed enough	Extremely deficient in detail
• Logical flow of written summary	Ideas presented in a logical and cohesive manner with style consistent throughout	Only a few minor inadequacies in logic and cohesion or changes in style	Significant amounts of the summary not well organised or disjointed or with changes in style	A large part of the summary disjointed and uncoordinated or with significant changes in style	Most of summary disjointed and uncoordinated with changes in style
• Clarity of written text	Summary very clear and readily understood. Grammar, punctuation and word choice appropriate	A few minor deficiencies in clarity. Minor errors in punctuation, grammar and word choice	Sections of the summary unclear and difficult to understand or poor punctuation, grammar and word choice.	A large part of the summary unclear and difficult to understand or with poor punctuation, grammar and word choice.	Very vague or ambiguous and difficult to follow with poor punctuation, grammar and word choice.
• Presentation of written summary	Summary extremely neatly organised and of the correct word length. Tables and/or figures used very well to augment text	Summary neatly organised and of the correct word length. Some use of Tables and/or figures to augment text	Summary partially disorganised or not of the correct word length. Minor use of tables or figures used to augment text	Summary disorganised or not of the correct word length and Tables and/or figures not used appropriately.	Layout is haphazard and either too long or too short. Tables and/or figures not used.
• Appropriateness and accuracy of referencing	Referencing accurate, appropriate and in correct format	Minor errors in referencing, use of citations or format	Substantial errors in referencing, use of citations or incorrect format	Insufficient and inappropriate referencing or incorrect format	Very few references, inaccurate citations and incorrect format

Table 6.  Staff Facilitator assessment form F-1

This Form is for the assessment of the oral presentation and is completed by a Staff Facilitator following the SPC presentation.
• Introduction to the topic	Clearly and concisely explained, very informative	Mostly clearly and concisely explained, informative	Some parts unclear and difficult to understand	Not very clear, difficult to understand or follow	Obscure/Prolonged
• Inclusion of all 4 themes* in the presentation	All 4 themes clearly present	All 4 themes present but very imbalanced	Only 3 themes clearly present	Only 2 themes clearly present	Only 1 theme clearly present
• Integration of biomedical science with clinical medicine	Connections very well demonstrated and integrated	Connections demonstrated and integrated	Only a few connections demonstrated	Connections not clearly evident	Connections not made
• Balance between the different aspects of the topics	Very broad coverage and balance of all topics	Broad coverage and balance of all topics	Coverage and balance of most topics	Not all topics covered and poor balance between topics	Focused on few aspects with little balance between topics
• Cohesiveness and smooth flow of presentation	Very cohesive, seamless presentation, Consistent style	Cohesive, seamless presentation	A few sections of presentation disjointed or uncoordinated	Many sections of presentation disjointed, uncoordinated	Entire presentation disjointed, uncoordinated
• Quality of presentation	Well structured, readily understood, maintains interest	Most sections well structured and readily understood	Some sections difficult to understand and interest lost	Not very clear, difficult to understand or follow in parts	Vague, obscure or ambiguous. Very difficult to understand
• Use of audiovisual aids	Very appropriate and well handled. High quality.	Appropriate and well handled.	Quality and use inconsistent, or inappropriate or not well handled	Quality and use inconsistent, inappropriate and not well handled	Inappropriate and inadequate throughout entire presentation
• Response to questions	Direct and very informative to all questions	Direct and very informative to most questions	Could not answer several questions	Could not answer many questions	Inappropriate or no answer

*As described in the text.

There has been much discussion of group assessment practices including issues of assessment of product or process and inequity of contribution (Webb et al. 1998; James et al. 2002; Willis et al. 2002). The SPC submissions (written and oral) are the products of group work. Assessment of these results and the assignment of group marks reflect the quality of the group product in relation to the specific assessment criteria. The quality of contribution to the planning and the performance in oral presentation of each student also contributes to the final product. Therefore, assessment was designed to incorporate suitable recognition of individual students relative contributions. The final SPC grade thus incorporates both group and individual assessment (Table 4). Both products of the SPCs (written and oral presentations) are assessed by staff and a group mark is thereby assigned to the written presentation. The oral presentation is assessed in two parts: group and individual. For the group mark, the assessment criteria include the content and its integration, as well as the cohesiveness and smooth flow of the presentation, which optimally require group management and engagement by all participants. Students are assessed individually on their contribution to the oral presentation, in relation to the content and delivery of their component (note that it is emphasised to students that they should all have equivalent roles in the presentation). Notwithstanding the natural wishes of students to be assessed for their individual roles, it has been reported (Willis et al. 2002) that group assessment was important to students as it recognised that the process of group learning has intrinsic value.

All students involved in the preparation of SPCs complete a self-assessment using the designated form. This was included to assist students with the development of self-assessment skills which are important elements of a reflective approach to personal and professional development, aspects that are emphasised in the Monash medical curriculum. In a broader educational context both self- and peer-assessment are important aspects of student learning. These are techniques which can be considered as lifelong learning skills (Boud 2000).

At the commencement of the SPCs students are provided with all assessment forms and criteria. This explicitly demonstrates that the assessment is transparent and equitable, and ensures that students are aware of the exact requirements of the various phases of the SPCs. Informal comments from the students indicated that this was very useful. Moreover, data from the student questionnaires (see below) showed that 37% of students used the assessment forms almost always when planning the written and oral SPC presentations, 29% most of the time, 16% half of the time, 12% occasionally and only a small minority (5%) never used the forms.

Groupwork

The SPCs are one component of the Monash medical curriculum which involves small group work. Informal verbal comments from students prior to the SPCs indicated students believed choosing their own groups would produce more effective working groups, ease the organisational burden and enhance the learning process. In open-ended questions in the questionnaires completed by students after the SPCs 34% of students included teamwork as a favourably expressed aspect of the SPCs and 20% listed teamwork skills as a skill they gained from the SPCs. Time management of the group was mentioned as a difficulty by 10% of students but only 2% had issues with team members who were underperforming. Underperformance of individuals within groups is a major concern of students when a group assessment is made (verbal communications from students). Students were required to provide peer assessment of all members of their group, which enabled adjustment of a particular student's individual marks to be made considering their contribution or performance. Although most students in this study receive high ratings from their peers, there was a small number of students (3.3%) who received ratings well below the mean indicating that significant underperformance can be tracked by these instruments. Closed questions related to groupwork (Table 7) show that participation in the SPC groups enabled students to appreciate both benefits and difficulties of teamwork. Further, in response to open-ended questions 74% of students commented that choosing their own groups enabled them to work well as a team with only 2% expressing a negative view.

Table 7.  Student responses to questions related to teamwork in SPCs. Data are expressed as the percentage of students replying (147 students)

	Hardly ever	Occasionally	About half the time	Much of the time	Almost always
Working in a team enabled me to appreciate the benefits of teamwork to carry out complex tasks. This applied to me:	5	12	20	40	24
Working in a team to plan, develop and present a topic enabled me to learn more broadly about that topic area than if I had simply studied on my own. This applied to me:	11	9	20	37	24
Working in a team (to plan, develop and present a topic) enabled me to appreciate the difficulties of teamwork to carry out complex tasks. This applied to me:	3	12	24	32	29
Choosing my own SPC group enabled me to work well as part of a team:	2	4	20	30	44

Strategies were applied to optimise the quality of group and individual contributions to the SPC preparation. This was achieved by means of explicit Staff Advisor policies for each of the presenting teams of students including: (a) attainment of skills by individual students, (b) effectiveness of group organisation embodying both collective and individual responsibilities. Moreover, the progress was explicitly tracked at each meeting with students, where Staff Advisors were required to complete an assessment form (Table 8 is an example). These forms do not contribute directly to the students marks but are reviewed by the SPC coordinator before the final assessment is determined. This enabled issues affecting particular groups to be readily identified, thereby triggering discussion with the relevant Staff Advisor. Follow-up occasionally involved meeting with individual students or groups as a whole, to trouble-shoot the participation or communication issues.

Table 8.  Staff Advisor assessment form AD-2

This Form is for the assessment of the Presenting Group at Advisor meeting 2 and is completed by the Staff Advisor. No numerical marks are awarded, the assessment is either satisfactory or not.
	Group	Student 1	Student 2	Student 3	Student 4	Comments
Attendance
Do students show evidence of working effectively as a group?
Is a management flow chart presented?
Have possible presentation formats been discussed within the group?
Do students have specific roles in researching information?
Does student act as spokesperson for group?
Does student have responsibilities in the group?
Does student participate in discussion?
Does student listen to others?
Written Summary
Does student have responsibilities in group for Written Summary?
Management Flow Chart	Advisor	Student 1	Student 2	Student 3	Student 4
Is the Management Flow Chart agreement form M-1 signed?

Overall student perceptions

Questionnaires completed by students after the SPCs included a number of closed questions and the following open-ended questions:

• “What did you most enjoy about your SPC experience?”

• “What was the worst aspect of the SPC experience?”

In response to question (A), 48% of student responses indicated that participating in or preparing the oral presentations were the most enjoyable aspects of the SPCs. The other most common responses to question (A) were: working in a team/group (27% of responses) and learning more about the specific topics (15% of responses). Typical comments made by students included the following:

“Presentation–doing role plays and making media clips”

“Coming up with creative presentation ideas”

“Presenting the information in a simple and easy to understand format”

“The opportunity to make a presentation with scope for creativity”

Question (B), in contrast, elicited student perspectives of negative aspects of the SPCs. There was a range of responses to this question with one frequently expressed concern being the timing of the oral presentations in the final week of semester and close to examinations (22% of responses). Various aspects of team/group work were also raised as negative issues; these perceived difficulties included: co-ordination of team members, communication between group members, collating individual contributions to group tasks (written and oral), group dynamics, and underperforming group members. When examining such data it should be kept in mind that the open-ended questions reveal only those opinions specifically elicited as either positive or negative highlights. This explains why team/group work has a high response rate as both a positive and negative aspect of the SPCs. Moreover, this reinforces the concept that the functionality of the team/group plays a substantial role in the quality of the products (written summary and oral presentation) generated by the students, reflected by the marks assigned.

Staffing considerations

The large number of students (approximately 300) participating in the SPCs and the relatively high staff/student ratio has imposed a high staff requirement. In dealing with this issue, staff with a range of backgrounds have been employed as Advisors (in the preparation phase) and Facilitators (for the oral presentations). These have included staff with medical qualifications, PhDs in biomedical fields, postgraduate students (mostly BSc Honours graduates undertaking PhD programs) and senior undergraduate medical students. The undergraduate medical students have either been in their fifth (final) year or have completed fourth year and have intermitted their MBBS course to complete a BMedSci (Bachelor of Medical Science) which entails a one-year research program equivalent to a BSc Honours year.

Training sessions together with extensive guidelines and tutor notes are provided, which both the Advisors and Facilitators feel is adequate (judged by responses from staff questionnaires). Comments in informal conversations with students participating in the SPCs indicate that all the tutors have been effective. However, the SPC students appear to relate particularly well to the senior medical students. The use of the senior medical students has been a successful response to the exigencies of a shortage of available tutors; it is also a valuable learning experience for such tutors themselves, as continuing education and teaching are integral components of medical practice.

Additional benefits

Indeed, such considerations lead us to contemplate the potential effects on the SPC students themselves in terms of their approach to future roles in which they engage assessment tasks. This may either involve students in being assessed in other learning domains or, in later stages of their training and professional development, in becoming the assessors themselves. The additional educative benefit arises from their exposure in the SPC environment to explicit and rigorous assessment instruments. These are expected to broaden student perspectives concerning how the attainment of skills and the execution of tasks can be appropriately and effectively assessed. This could well be one of a number of additional beneficial outcomes that were not well anticipated at the inception of the SPC program.

One aspect related to the enhanced appreciation by the students of the underlying rationale and mechanism of rigorous assessment is the potential for students to develop concerns based on their considerations of some or all of the assessment context. This notion of consequential validity (Messick 1995) describes the possible impact on validity of assessment instruments due to beliefs or attitudes that the students themselves hold about many different aspects of the assessment process itself. A detailed discussion of these issues is beyond the scope of this report.

Because of the structured nature of the SPC program another advantageous outcome is likely to be the attainment of greater levels of student confidence in addressing new or unfamiliar tasks. Collectively, these benefits contribute to general personal development of the medical students who pass through this program.

Conclusion

The SPCs were designed with the aim of providing students with a framework in which they could be active learners developing higher order learning skills. The data presented shows that the majority of students did use the higher order learning skills of integration, evaluation, interpretation and synthesis in the preparation of the SPCs. The SPCs were also shown to develop deep approaches to learning as demonstrated by students commitment to understanding the material, critically examining new facts and ideas, and tying them into their prior learning.

The detailed objective assessment proformas were successful learning aids for the students. Specifically they explained the measured constructs clearly, thus giving the evaluator a sense of how to appraise the quality of student performance. The assessment proformas are readily modifiable to allow modifications to the SPC assessment or to be modified for use in other course or activities. Teamwork is an integral component of the SPCs which many of the students enjoyed, however, it did raise the issue of equitable assessment which has been addressed by the inclusion of a number of different assessment modalities including peer, staff, group and individual.

The SPCs are a successful active learning program which engages students and encourages deep learning and could readily be adapted by a diverse range of courses. The SPCs also develop the Monash graduate attributes of the life-long learning skills of written and oral communication, capacity for inquiry and research, critical thought and analysis, problem solving and teamwork.

Ethics approval

This study has received ethical approval from Standing Committee on Ethics in Research involving Humans, Monash University, Number 2006/81ED

Acknowledgements

We acknowledge Ramash Rajan, Jane Tracey, Malcolm Eley, and the members of the SPC development committee for their valuable discussions and ideas. Elaine Pearson and Karen Poole are thanked for their assistance in collating data from student questionnaires.

Dedication

This paper is dedicated to the memory of Malcolm Ely: an enthusiastic mentor in sound educational practice.

Additional information

Notes on contributors

Janet Olwyn Macaulay

JANET OLWYN MACAULAY is a Lecturer in the Department of Biochemistry and Molecular Biology, Monash University, who has a strong interest is teaching and learning particularly in Medical and Biomedical education, including assessment practices and the design of innovative leaning activities

Phillip Nagley

PHILLIP NAGLEY has a personal chair in the Department of Biochemistry and Molecular Biology, Monash University, and is engaged in designing and implementing innovative educational activities for a variety of student cohorts in undergraduate biomedical science and medical courses alongside active research programs in molecular and cell biology.