Health, Medicine and Behavioural Sciences Written Formulation and Case Management in Mental Health

The impetus for the development of this assessment was the logistic problems posed with transition to a semester-based course in which teaching time was shared with cognate disciplines and assessment moved from every 8 weeks (corresponding to a clinical placement) to end-of-semester. Delivery of previous viva examinations was no longer possible in end-of-semester examinations because of the large numbers of students and the number of international students studying overseas, meaning that they would otherwise be compelled to return to UQ for assessment. We introduced this assessment in 2019 and have conducted two end-of-semester examinations and deferred and supplementary examinations.

The assessment represents a "surrogate" or approximation of the previous viva examination which was our most discriminating assessment item. In 2019 the assessment demonstrated an acceptable range in the standard of student responses similar to the previous viva examinations.

The advantages are listed below:

• The assessment writing is less time-consuming than the case development required for the previous viva examinations
• We are no longer making requests for clinical teachers to spend a morning examining in vivas (5 times per year, corresponding with the previous 8-week clinical placements) and asking professional staff to arrange the examination teams as the written examination is delivered in one location including in Ochsner
• We develop pre-determined marking criteria and rules for grading critical errors/omissions
• We do not face the type of student challenges to their grades as previously in the viva – although examiners had marking guides these were not always robustly followed and students could argue along the lines of "well I did say that, even if the examiner didn't mark that I had"
• We grade the written essays centrally and can double or triple mark easily. Marking can be done remotely as the electronic database is secure and easily accessed
• We now have the capacity to develop clear summaries for student feedback based on actual written material rather relying on sometimes rudimentary viva examination notes obtained from different examination sites. We send this feedback to clinical teachers who report that this is very helpful in guiding their teaching
• Remarks are remarks – we are able to have an independent examiner assess the original script rather than devising a new assessment
• The assessment allows us to clearly appraise the quality of writing of students– documentation is fundamental in medical practice and this in turn informs our feedback to students. In addition, the explicit instruction to not use abbreviations is important as many errors in clinical practice arise in relation to abbreviations
• Using strict character limits conveys the importance of being succinct and is in line with clinical practice in which copious notes risk not being read
• The focus on marking based on specific tailoring and prioritisation of management reflects clinical practice and embeds the importance of this in student's minds

Marking is time consuming as is writing feedback on performance of individual students – over 200 per semester
Determining marking adjustments for critical errors is challenging and it is impossible to devise a rubric for every possible error
Use of a written examination in place of a viva means that students whose first language is not English may be at increased disadvantage
In a viva examination an examiner can prompt a student in which case a student may self-reflect and identify errors which is not possible in a written examination
We lose an opportunity for demonstration of professionalism by experienced clinicians who examined students in vivas
 

Use of the electronic platform is critical for success of this strategy – written student texts are challenging to mark. The electronic platform means flexibility with marking as scripts can be marked remotely

Examination is invigilated and student essays are uploaded to a protected electronic database.