Department of Pharmacy, Faculty of Science (FoS)
Han Zhe converts an in-person, skills-based assessment into an online mode. She shares three lessons that have contributed to the assessment’s successful implementation online.
The COVID-19 pandemic created unique challenges for healthcare professional education, where skills training is essential and frequently involves in-person, one-on-one assessments and feedback. Such teaching and assessments are no longer feasible with current safe distancing measures which entail classes and assessments shifting to online learning. Educators therefore have to explore alternative ways to teach and assess professional skills.
For the last three years I have taught patient case presentation skills in the module PR3137 “Pharmacy Professional Skills Development III” to third-year undergraduate pharmacy students. Patient case presentation skills were taught in lectures, practised in tutorials, and assessed in-person where students develop a therapeutic plan for their assigned patient case and subsequently present the plan one-on-one to a faculty or practicing pharmacist.
Last semester, I converted the in-person assessment to a timed online assignment. A total of 80 minutes was allowed, during which students had 60 minutes to review patient information on the Department of Pharmacy’s mock electronic health record (i.e. miPEER) and develop a therapeutic plan, 10 minutes to audio record the presentation, and 10 minutes of buffer time to save and upload the audio file (see Figure 1) onto the University’s learning management system (i.e. LumiNUS).
I conducted a 45-minute class debrief on Zoom immediately after the submission deadline, during which many students asked questions to clarify their therapeutic plans. I was encouraged by the increased level of engagement as compared to in-person debriefing sessions and attributed it to two factors. Firstly, more time was allocated for the online debrief. In previous years, more time in-person was dedicated to assessment with limited time (i.e., 15 minutes) for the debrief. With the timed online assignment, students could audio record their submission at any time within the allocated time frame and need not wait for an assessor to be available. Secondly, the chat function also encouraged quieter students to participate.
I would like to share several factors which contributed to this success in three takeaway lessons.
Lesson 1: Provide simple and clear instructions at one location
This assignment requires students to access miPEER and two additional folders within LumiNUS. While patient information could have been made available in LumiNUS, I elected not to do so because I wanted students to still have the authentic experience of retrieving information from an electronic health record which is a necessary skill for future practice.
I used the “Weekly Learning Flow” function in LumiNUS (see Figure 2), where links to various folders and miPEER were available at one location, with instructions made available one week before.
Students also experienced doing an audio recording and uploading their audio files earlier in the semester. This familiarity with technology facilitated a smooth process on the day of the assignment. Should any technology or tools be new, it would be prudent to conduct a trial run beforehand.
Lesson 2: Have a backup plan
I developed a backup plan in case LumiNUS or miPEER systems experienced downtime (see Figure 3). I had PDF files of patient information from miPEER and a contact list of all students on hand which I could email them easily. Fortunately, no backup plans were activated but having one gave me as well as the students peace of mind.
Lesson 3: Offer support and make reasonable adjustments
A laboratory technician and I were available on Zoom throughout the assignment (see Figure 4). Students were assured that someone would be available to assist should they encounter any technical difficulty or require any clarifications during the assignment.
Some students experienced internet or device slowness when saving or uploading their audio files. I accepted late submissions as long as students provided an explanation via email. The vast majority of these files were uploaded only a few minutes past the deadline.
Academic integrity in online assessment is a concern of all educators. This patient case presentation assignment is an open-book assessment. It mimics real-world practice where pharmacists access drug information resources, and the cognitive task involves applying the relevant drug information while integrating it with patient-specific information. The assignment required application of knowledge and the time allocated was also stringent. Both of these factors discouraged students from discussing with one another. There were no two recordings that were overly similar.
In summary, a timed online individual assignment was conducted in place of an in-person one-on-one assessment. A similar approach may be considered for other skills-based, healthcare education assessments. However, a caveat is to ensure that the mode of assessment allows important learning outcomes to be assessed. While audio recordings allow assessment of patient case presentation skills, evaluation of other communication skills may require assessment of non-verbal cues or require faculty-student interaction where alternatives (e.g. video conferencing) may be more appropriate.
HAN Zhe, PharmD, BCPS, BCIDP is a lecturer with the Department of Pharmacy, NUS. She also maintains an active clinical practice as a Principal Clinical Pharmacist at the Ng Teng Fong General Hospital. As an educator and clinician, she believes in integrating real world scenarios and patient cases into her teaching in the classroom and empowering her students to be active participants in their learning process.
Han Zhe can be reached at firstname.lastname@example.org.