Summative Assessment

Introduction

Module and Professional Setting:

This series of tutorials focused on Type 2 Diabetes Mellitus in Primary Care: Diagnosis and Management
was conducted in a primary care clinic. Healthcare professionals, including general practitioners, nurses,
and medical students, were trained and updated on the latest guidelines and practices related to type 2
diabetes. As the medical tutor in the workshop, my role was to guide participants through the tutorials on
Type 2 Diabetes Mellitus in Primary Care. I facilitated learning by delivering presentations, sharing
information, and encouraging discussions. I ensured an interactive and engaging format, promoting active
participation and application of knowledge through case-based scenarios and group activities (Sturt et al.,
2008, Sturt et al., 2005). The educational strategy employed in these tutorials aimed to provide healthcare
professionals with the knowledge and skills necessary to effectively identify signs and symptoms,
interpret test results, and make informed decisions regarding diabetes medications in a primary care
setting (Emami et al., 2020, Anderson et al., 1991).

Number and Dreyfus Level of Learners:

The Dreyfus model is a framework that describes different stages of skill acquisition and expertise
development. It identifies five levels: novice, advanced beginner, competent, proficient, and expert. In the
context of this module, the group of learners consisted of approximately 15 participants who were already
at the proficient level of the Dreyfus model. They had acquired a solid foundation of knowledge and skills
related to diabetes care, including a deep understanding of the pathophysiology, risk factors, and basic
management principles associated with type 2 diabetes (Spann et al., 2006, Ramsburg, 2010). The module
aimed to build upon their existing knowledge and elevate their expertise to enhance their ability to
provide optimal care for individuals with type 2 diabetes in a primary care context (Mauldin, 2021,
Carraccio et al., 2008).

Resources Available for Assessment Strategy Implementation:

In the primary care clinic, various resources were available to effectively implement the assessment
strategy for this module. The team of healthcare professionals, including physicians, nurses, and
educators, contributed their expertise and facilitated the assessment process. The clinic's facilities

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included a well-equipped lecture room with audiovisual aids, such as projectors and screens, to facilitate
engaging presentations (Sperl-Hillen et al., 2013). Breakout rooms were utilized for group discussions,
interactive activities, and case-based learning exercises, promoting active participation and collaborative
learning (Almendingen et al., 2022). Additionally, comprehensive teaching materials, including medical
textbooks, guidelines, research articles, and online resources, were utilized to support the learning process
(Hall et al., 2007). Reliable testing and evaluation tools, such as online platforms, were used to assess the
learners' proficiency in diagnosing and managing type 2 diabetes in a primary care setting. The
assessment methods utilized align with the principles of adult learning, promoting active engagement and
critical thinking among the learners to manage T2DM effectively in the primary care setting (Mauldin,
2021, Deakin et al., 2005).

Task 1

SMART Learning outcomes:

Learning Outcome Domain of Instructional Assessment Technique

Learning Method

Identify and differentiate the Cognitive Presentation, case Formative assessment:

signs and symptoms of type 2 studies Multiple-choice questions
diabetes. on signs and symptoms

Interpret laboratory test results Psychomotor Hands-on activities, Formative assessment:

commonly used in diagnosing data analysis Interpretation of sample lab
and monitoring type 2 diabetes. results in case scenarios

Evaluate the appropriate timing Affective Group discussions, Formative assessment:

for initiating diabetes guideline analysis, Group discussion on case
medications based on patient OSCE scenarios and Objective
characteristics and guideline Structured Clinical Exam to
recommendations. determine appropriate
timing for medication
initiation

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 Formulate an individualized Affective Case studies, Summative assessment:
diabetes management plan for a problem-solving Written case study analysis
patient, considering lifestyle activities and management plan
modifications, medication
regimens, and monitoring
strategies.

When creating the learning outcomes (LOs) for the module on Type 2 Diabetes Mellitus in Primary Care,
I carefully considered the appropriate level of complexity for the learners. I considered the learners' prior
knowledge and aimed to build upon their existing foundation of knowledge and skills related to diabetes
care (Kegels et al., 2008). By incorporating the Dreyfus model, which identifies levels of proficiency, I
ensured that the LOs were pitched at the proficient level, where learners have a deep understanding of the
subject matter and can apply their knowledge effectively (Benner, 2004).

To determine the learners' prior knowledge, I conducted a needs assessment and gathered information
about their educational background, professional experience, and familiarity with type 2 diabetes
management. This helped me gauge their baseline understanding and tailor the LOs to meet their specific
needs. By incorporating case studies, problem-solving activities, and discussions, I allowed learners to
draw on their prior knowledge and experiences, facilitating active engagement and deepening their
understanding (Kalkan et al., 2007).

In creating SMART LOs, I considered the characteristics and needs of the learners, their Dreyfus learner
level, and the domains of expected learning (cognitive, psychomotor, and affective). To determine where
to pitch the LOs within the three domains of learning (cognitive, psychomotor, and affective), I drew
upon Miller's Pyramid, Bloom's Taxonomy, and the Revised Bloom's Taxonomy (Wheeler, 2005).
Miller's Pyramid suggests a progression from knowledge and comprehension to application, analysis,
synthesis, and evaluation (Rhind et al., 2021). Bloom's Taxonomy provides a framework for classifying
educational objectives and encompasses six levels: remembering, understanding, applying, analyzing,
evaluating, and creating (Chandio et al., 2016). The Revised Bloom's Taxonomy further expands on these
levels, incorporating action verbs and linking them to cognitive processes (Conklin, 2005).

Based on these models, I crafted LOs that encompassed different levels of cognitive complexity, such as
identifying signs and symptoms (remembering), interpreting laboratory test results (applying and
analyzing), evaluating appropriate medication timing (evaluating), and formulating an individualized

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management plan (creating) (Mauldin, 2021). By incorporating hands-on activities, case studies, and
group discussions, I ensured that the LOs also addressed the psychomotor and affective domains,
enabling learners to practice skills and engage in critical thinking and decision-making processes (Kalkan
et al., 2007, Vég, 2006).

By aligning the LOs with these frameworks and taxonomies, I aimed to create a balanced and
comprehensive learning experience for the learners. It allowed them to progress from foundational
knowledge to higher-order thinking skills, developing a deeper understanding of type 2 diabetes
management in primary care (Anderson et al., 1991). Studies have shown that learner-centered
approaches, such as incorporating case studies and problem-solving activities, enhance engagement,
critical thinking, and knowledge retention (Susan Sandstrom, 2006, Trento et al., 2004). Additionally,
these frameworks provided guidance in selecting appropriate action verbs and instructional methods that
facilitated the achievement of the LOs and the learners' growth within the cognitive, psychomotor, and
affective domains (Nguyen and Gu, 2013, Van den Arend et al., 2000).

Task 2

Blueprint

Assessment Methods

MCQs/SBA Case-based OSCE (Objective ePortfolio

exam discussion Structured Clinical
Exam)
Learning Outcomes
40% 30% 20% 10%

Identify and differentiate the signs ✓

and symptoms of type 2 diabetes

Interpret laboratory test results ✓ ✓

commonly used in diagnosing and
monitoring type 2 diabetes

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 Evaluate the appropriate timing ✓ ✓
for initiating diabetes medications
based on patient characteristics
and guideline recommendations

Formulate an individualized ✓ ✓ ✓
diabetes management plan for a
patient, considering lifestyle
modifications, medication
regimens, and monitoring
strategies

The Utility Index is a framework used to analyze and evaluate the effectiveness and appropriateness of an
assessment technique in terms of its validity, reliability, educational impact, acceptability, and cost
(Chandratilake and Davis, 2010). It allows for a comprehensive assessment of the utility and value of an
assessment method within a specific context. MCQs were selected as the assessment technique for this
module on Type 2 Diabetes Mellitus in Primary Care due to several reasons.

 Validity: MCQs demonstrate high content validity as they can be designed to align closely with
the learning outcomes and content covered in the module (Hess and Davis, 1983). Research
supports the validity of MCQs, stating that well-constructed MCQs can effectively assess
knowledge and understanding (Yeong et al., 2020, Khafagy et al., 2016).
 Reliability: MCQs can achieve high reliability when designed with clear and unambiguous
questions, well-defined answer choices, and consistent scoring criteria (Khafagy et al., 2016). A
study showed that MCQs can have high inter-rater reliability when scoring is standardized
(McCoubrie, 2004, Norcini et al., 1985).
 Educational Impact: MCQs have a positive educational impact as they require learners to actively
retrieve information, apply concepts, and make decisions within the given options. This process
aids in knowledge consolidation and retention. Studies highlight the educational benefits of
retrieval practice, which is inherent in MCQ assessments (Norcini et al., 1985, Chan et al., 2011).
 Acceptability: MCQs are widely accepted and familiar to learners, as they are a commonly used
assessment format in medical education. Learners perceive MCQs as fair and objective,
contributing to their acceptability. A study by Simbak (2014) found that medical students rated
MCQs as highly acceptable and relevant (Simbak et al., 2014).

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  Cost: MCQ assessments are cost-effective compared to resource-intensive methods such as
OSCEs or simulations. They require minimal resources in terms of question development,
scoring, and administration. The automated scoring feature of MCQs reduces the time and cost
associated with manual scoring (Pugh et al., 2020).

Task 3

Choice of Standard Setting Method: Modified Angoff Method for MCQs/SBA Exam

Among the assessment techniques used in the module, the Multiple-Choice Questions (MCQs)/Single
Best Answer (SBA) exam was selected for further analysis. The appropriate standard setting method for
this assessment technique is the Modified Angoff method. The Modified Angoff method is a widely used
standard setting approach that involves expert judges estimating the probability of a minimally competent
candidate correctly answering each test question (Ferdous and Plake, 2005). These estimates are then
averaged to determine the cut-off score or passing mark (Ricker, 2006).

The choice of the Modified Angoff method is justified for several reasons. Firstly, it allows for the
involvement of subject matter experts who possess the necessary knowledge and expertise in type 2
diabetes management. Their judgments are crucial in determining the level of knowledge and competency
required to pass the examination (Yim, 2018). Secondly, the Modified Angoff method aligns well with
the resources available in the setting. It does not require extensive resources in terms of time, manpower,
or financial investment. It can be implemented with a panel of expert judges who can provide their
estimates independently and subsequently reach a consensus (Hurtz and Auerbach, 2003).

Other standard setting methods, such as the Bookmark method or the Borderline Group method, may not
have been as suitable for the MCQs/SBA exam in this setting. The Bookmark method requires extensive
statistical analysis and may not be feasible in resource-constrained environments (Ananthanarayanan and
Abhilash, 1999). The Borderline Group method relies on comparing the performance of borderline
candidates, which may not provide a sufficiently objective and accurate standard in this context (Homer
et al., 2017). Evidence from the literature supports the use of the Modified Angoff method in various
settings and disciplines. A study by Mubuuke (2017) examined different standard setting methods and
found the Modified Angoff method to be reliable and practical (Mubuuke et al., 2017). Another study by
Hurtz and Auerbach (2003) highlighted the use of expert judgment in the Modified Angoff method and its
applicability to high-stakes assessments (Hurtz and Auerbach, 2003). By utilizing this method, we can
establish a fair and valid passing score, ensuring that learners are appropriately assessed in their
knowledge and understanding of type 2 diabetes management.

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The Borderline Regression Method is the most appropriate standard setting method for the Objective
Structured Clinical Exam (OSCE) in this module on Type 2 Diabetes Mellitus (Geddes and Piasentin,
2016, Homer et al., 2017). Supported by evidence from Fidment (2012) and Shulruf (2015), this method
analyzes the relationship between exam scores and expert examiners' judgments of borderline candidates'
performance. It ensures a reliable determination of the pass/fail threshold, distinguishing between
competent and non-competent candidates based on their skills and competencies in diabetes management
(Shulruf et al., 2015, Fidment, 2012).

Task 4

Assessment Bias: Halo Effect (OSCE)

For the OSCE, one assessment bias that may be encountered is the halo effect. The halo effect refers to
the tendency of examiners to let their overall impression of a candidate influence their scoring across
multiple stations, rather than objectively assessing each station separately (Nisbett and Wilson, 1977).

To avoid the halo effect bias in the Objective Structured Clinical Exam (OSCE), strategies such as
examiner training and calibration, standardized patient encounters, and blind scoring can be implemented.
Examiner training and calibration sessions ensure a clear understanding of assessment criteria and scoring
rubrics. Standardized patients provide consistency in case portrayal, while clear checklists and rating
scales minimize subjective impressions (Schleicher et al., 2017). Blind scoring, which involves removing
candidate identification information from scoring sheets, has been shown in a study by Uchida (2017) to
effectively reduce biases and ensure fair assessments in OSCEs (Uchida, 2021). By eliminating
preconceived notions or biases based on candidate identity, blind scoring allows examiners to focus solely
on candidate performance and responses.

Assessment Bias: Construct-Irrelevant Variance (MCQ Exam)

For the MCQ exam, one assessment bias that may be encountered is construct-irrelevant variance. This
bias occurs when factors unrelated to the construct being assessed influence the scores. For example,
poorly written or ambiguous questions may introduce irrelevant variability in the responses (Zhai et al.,
2021).

To mitigate construct-irrelevant variance in the Multiple-Choice Questions (MCQ) exam, rigorous

question development and review processes are essential. Involving subject matter experts and educators
in question development ensures high-quality, relevant questions (Downing, 2002). Pilot testing and item
analysis help identify and eliminate poorly performing or ambiguous questions. Content coverage and

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item difficulty should accurately reflect type 2 diabetes knowledge and competencies. Careful item
selection and validation processes that ensure a representative range of content and difficulty levels in the
MCQ exam can minimize the impact of irrelevant factors on the scores, ensuring that the assessment
accurately reflects the knowledge and competencies required in the primary care setting (Hess and Davis,
1983). Evidence from the literature supports these strategies, highlighting the importance of rigorous item
development, while emphasize content coverage and item difficulty as factors influencing MCQ exam
validity and reliability (McCoubrie, 2004, Haladyna, 2004).

By implementing these strategies, such as examiner training, calibration, standardized patient encounters,
blind scoring for the OSCE, and rigorous question development, review processes, and content coverage
for the MCQ exam, the biases associated with each assessment technique can be minimized, leading to
more valid and reliable assessments in the context of type 2 diabetes in primary care.

Task 4

SMART Professional Development Plan (PDP)

Reflecting on Module 3, it has had a significant impact on my professional identity formation as an

educator. The in-depth exploration of assessment strategies has deepened my understanding of the
importance of aligning assessments with learning outcomes and ensuring validity and reliability. This
module has inspired me to further develop my expertise in assessment design and implementation.

To fulfill this goal, my SMART action item for future professional development is to enroll in a
certification program in assessment and evaluation within the next six months. This action item is
Specific (enrolling in a certification program), Measurable (completion of the program and obtaining a
certification), Achievable (accessibility of relevant programs), Relevant (enhancing assessment
expertise), and Time-bound (within the next six months). This certification program will provide
comprehensive training, allowing me to refine my assessment skills, stay updated with best practices, and
make informed decisions in my role as an educator.

Appendix

Formative Assessment

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 Wee Tutorial Topic Learning Outcome Instructional Formative
k Method Assessment

1 Identify signs LO1: Recognize common signs and Presentation and MCQ (40%)
and symptoms symptoms of type 2 diabetes group discussion

LO2: Explain the relationship

between signs and symptoms and
pathophysiology

2 Identify signs LO1: Recognize common signs and Standardized OSCE (20%)
and symptoms symptoms of type 2 diabetes patient encounters

LO2: Apply clinical reasoning to

identify potential underlying causes

3 Interpreting test LO3: Interpret laboratory test results Case-based MCQ (40%)
results commonly used in diagnosing and scenarios and
monitoring type 2 diabetes discussion

4 Interpreting test LO3: Analyze the significance of test Standardized OSCE (20%)
results results and their implications for type patient encounters
2 diabetes

5 Diabetes LO4: Understand the indications, Lecture and case MCQ (40%)
medications contraindications, and side effects of studies
diabetes medications

6 Diabetes LO4: Apply knowledge of diabetes Interactive role- OSCE (20%)

medications medications to clinical scenarios play and discussion

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