Teaching Strategies and Techniques

A flipped exam” is how the authors describe this unique group exam activity. The students, all enrolled in a post-baccalaureate program at Wayne State University School of Medicine, had applied to the medical school and not been accepted, but showed promise. This 10-month program helps students from underrepresented backgrounds “improve their scientific knowledge, academic skills, and personal adjustment.” (p. 339) The flipped exam activity happened in a 20-class-session cardiopulmonary unit of a physiology course. Students started the unit with a 300-page course pack. Faculty told the students that not all the material in the pack would be covered in class, but that they would be tested on the entire pack. Following three lecture days, students participated in a collaborative exam experience (45 test questions) in which about 30-35% of the material had not been talked about in class. They had four hours to answer the questions, and the class used more than the allotted time, indicating to the faculty researchers that the students were committed to the process and invested in their learning. The next session, the exam debrief, provided another surprise for the faculty. They write that the “session promoted deep, meaningful learning as the students and professor deconstructed each question and the corresponding answer choices, exposing misconceptions, inconsistencies, and biases (often what we think we know prevents us from learning what we do not know). In this way, the students explored why answers were correct as well as incorrect while understanding principles and concepts.” (p. 340) The level of collaboration among students may have been the result of how the exam was graded. Fifty percent of the grade was based on performance on the exam, and the other 50% came from behavioral parameters that included communication, collaboration, problem-solving, decision-making, initiative, critical integration of knowledge, professional attitudes, grit (as in perseverance), motivation to learn (not just get the right answer), and ethics. (p. 340) “We did not want the entire grade to be based on work that rewards only correct answers. We chose to reward students for participation and effort as well as engaging with the material because this approach has been shown to stimulate student interest in improvement.” (p. 340) Much of the article is devoted to justification of this collaborative approach to exams. The team approach is analogous to how medicine is now practiced. “This team effort is essential given the complexity of information and interpersonal connections as well as the fact that it is impossible for one individual to provide care in isolation and it is potentially dangerous.” (p. 340) Then there's how traditional approaches to testing affect learning. Students are motivated to study for exams so that they won't get bad grades. This approach changes that motivation because now exams test “how well students perform when they have an opportunity to collaborate with and learn from peers.” (p. 341) “Students learn better because the flipped exam provides opportunities for students to construct, articulate, and defend logical responses to complex questions or problems, provides immediate feedback to students about their knowledge and understanding of content, and provides students the opportunity for the utilization of this feedback to improve their performance.” (p. 341) Did low-performing students get “carried” by high-performing students? Based on observations during the four flipped exam sessions, this team reports that it seldom happened. They also cite previous research documenting that students with the right answer (regardless of whether they are high- or low-performing students) can effectively persuade students with a wrong answer to change to the correct answer. The grading mechanism used here also prevented freeloading. The authors do acknowledge that exam approaches like these generate a good deal of resistance from faculty who consider exams measures of individual mastery of material and who think that sharing information during an exam is the same thing as cheating. The authors believe the time has come to challenge these long-held beliefs and start thinking more about exam experiences as opportunities for students, not just to get grades but to truly master the material. Reference: Lujan, H. L., and DiCarlo, S. E. (2014). The flipped exam: Creating an environment in which students discover for themselves the concepts and principles we want them to learn. Advances in Physiology Education, 38 (4), 339-342.