The studies we have published (here and here) demonstrated how assessment cultures have remained rooted in a behaviourist approach to medical education: students are rewarded for passing and punished for failing assessments.
The studies also supported a move towards a more constructivist approach to assessment, empowering the students to take a more active role. Other constructivist elements were a clear call for more authenticity in assessments and the benefits of mentoring, with gradual descaffolding as the course progresses. A behaviourist approach to learning in medical education, relying on didactically-delivered lectures to passive students, now seems increasingly outdated, but a behaviourist approach to assessment has mostly persisted. Even in institutions which have adopted active approaches to learning, the associated assessments have often rewarded superficial learning strategies, which students understandably adopt.
Just as the concept of a patient as a passive recipient of healthcare seems obsolete in the internet era, so the idea of a student passively accepting the rewards and punishments of an assessment system based on behaviouristic principles appears archaic and increasingly difficult to defend. This may at least partly explain why student surveys almost always demonstrate much less satisfaction with assessment and feedback than with other aspects of the course.
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