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Episode 2 | Transcript
Testing As a Teaching Strategy
Kevin Patton: Is administering a test to your class best used to assess how much learning your students have done or is administering a test in your class best used as a strategy for learning in the first place? Well, in my opinion, the answer is a definite yes.
Aileen: Welcome to The A&P Professor, a few minutes to focus on teaching human anatomy and physiology with host, Kevin Patton.
Kevin Patton: Well, I’m making plans for this summer, going to the big HAPS Conference, Human Anatomy and Physiology Society has their big annual conference coming up in Columbus, Ohio before too long. I was just looking at my files and I realized that the first HAPS Conference I went to was in 1990 in Madison, Wisconsin. Gary Johnson, my old friend, was the conference host and organizer that year and it was at that meeting that I remember we voted to actually create the Human Anatomy and Physiology Society. I haven’t missed one annual conference since.
Kevin Patton: I learn so much at those conferences and I tell you, half of what I learn isn’t in the sessions. I learn a lot in the sessions. They’re update sessions where we have various experts and very focused fields come and update us on what some of the latest things are that help inform our teaching of human anatomy and physiology. We’ll do that for a couple of days. At the same time, we’re visiting with various vendors, including publishers and suppliers of equipment and other kinds of resources. Then, usually the next two days we spend out at the host campus. We’re doing workshops and taking mini field trips and things like that and learning from each other. The whole time, there’s all kinds of opportunities for interacting with one another. Whether it’s a two or three-minute, hello, I’m Kevin. I’m from Missouri. Where are you from and what do you do and we start to chat or it could end up being a whole half hour or hour-long conversation. If any of you have gotten trapped into a conversation with me, you know that I can just keep talking on and on and on.
Kevin Patton: If you’ve never been to one, you have to try it. I know it’s a big sacrifice in terms of time and money to get there and do that, but it’s well worth it and it can really reenergize you. I swear, I know people who were burned out on teaching or burned out on teaching A&P, and this revitalized them. They went on to do super, wonderful things for decades after that and I am not making that up. This happens all the time. It’s something you’ve got to go to. I strongly encourage you and my plan is to be there. When you see me around, grab me and say hello and we’ll chat a little bit, so do that. Go to the website, which you can find in the show notes. It will take you right to the conference page, so you don’t have to hunt around and go ahead and sign up. Do it quick before the hotel fills up.
Kevin Patton: Hypertension. You probably heard the big news at the end of 2017 about the new guidelines. Technically, they’re called the 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults and really kind of made a big splash in the news because now all of a sudden, a lot more people under the new guidelines can be labeled as having elevated blood pressure or hypertension because the numbers have shifted a little bit. When you sort of dove into it past the headline, you find out that, well, not as much has changed as we think in terms of these recommendations.
Kevin Patton: One of the main authors stated that we’re still going to talk about 120 over 80 as normal, even though technically it’s like right across the border into elevated area, but we can still talk about that as a normal starting point of a discussion and anything above that we’re going to say, look, this might be a cause for concern. We’re going to look at you as an individual, which is of course the trend we’ve seen for quite a while in clinical medicine, right, is that more and more of evaluation of the whole story behind a patient, not just this number alone and that number alone.
Kevin Patton: These new guidelines are really emphasizing that approach and another thing that really, really makes me happy is that they really point out that if you’re going to manage blood pressure or even assess it correctly, you need to teach the patient how to do that, do it in their own environment, and take a number of readings. That one reading that you get or maybe two readings that you get in the doctor’s office during your checkup is not necessarily going to be indicative of much of anything. I know that’s true for me. My blood pressure, even though I love my physician, I love his staff, I always have a good experience other than occasionally being sick when I go into their office, I have a higher blood pressure, significantly higher blood pressure when they are taking my blood pressure than when I’m at home.
Kevin Patton: I brought in my own blood pressure apparatus. Had it calibrated to that in the office and so I know that they’re reading the same numbers. Then, when I do it at home, it’s much better. They are much lower numbers and apparently, I’m not the exception to the rule. Apparently, most people get what they sometimes call White Coat Syndrome and get high blood pressure when somebody else is taking it, especially if they’re a clinical person. These guidelines’ kind of fit into that and say make sure it’s taken correctly and make sure you’re not looking at just one number. Take into account the fact that a number taken clinical is not necessarily the true, baseline, resting blood pressure.
Kevin Patton: Now, another thing that has happened here. You may remember under the old guidelines that pre-hypertension was a category that you might be in before you are actually classified as having hypertension. Now, the categories go this way. There’s normal blood pressure, so that goes up to 120 over 80 and then once you cross that line, you’re now in the area of elevated blood pressure, which used to be called pre-hypertension, but now we’re calling it elevated blood pressure. Then, once we get to 130 to 139 over 80 to 89, now we’re in hypertension and that’s divided up into stage one and stage two. Once we hit 140 over 90, then we’re in stage two hypertension and once we get to 180 over 120 or either of those numbers get hit, and 180 or the 120, then we’re in what’s called the hypertensive crisis, so that’s kind of a new designation as well.
Kevin Patton: I don’t know about you, but in my A&P courses, I don’t necessarily get into a whole lot of the diagnostics and so on, of blood pressure, although we do go through these categories and kind of point out that this is a big health issue and so on. To boil it down, what do we need to know for those of us who aren’t really going into the clinical end of things, at least not too much? One is, you probably need to update whatever chart you’re using to cut off the blood pressures and most of the textbooks don’t have that in them yet because it’s too new and, well, you know, production of a textbook takes a long time, so they’re not going to necessarily get in there right away. It’s also good to remember that a blood pressure of 120 over 80 is still considered a starting point for discussing blood pressure, so you don’t have to change out all your diagrams that show that is the sort of starting point or even just as an example of blood pressure, period.
Kevin Patton: Also, consider bringing this up in your class and talk about the fact that this was recently changed and that guidelines for diagnosis, prevention, treatment, various other clinical recommendations, they often change over time. You can discuss, well, why is that? Why do they change? Is it the human physiology that’s changing? Well, no, that’s not right. Of course, it’s how much we know and what experience we’ve had in terms of treating people and the best way to treat people, especially when you’re looking at the big picture of public health. Anyway, just want to bring you up to date in the show notes, and also in the episode web page at TheAPProfessor.org. I have actually a free slide you can use that has the new charts and a bunch of links to various articles and even the official publication of the new guidelines if you want to dive into those.
Kevin Patton: In a previous podcast, I talk about spaced retrieval practice, that is the idea of using tests and quizzes in a formative way, that is as a teaching and learning tool, rather than in a summative or evaluative way in it being an assessment of their final learning. When you use testing as a teaching and learning tool, there are a variety of ways to do that. In a previous episode, I talked about how I’ve created my own test bank of test items and give the students many more tests than I did in the olden days.
Kevin Patton: They’re all online tests and they’re randomized so they don’t always get the same version of a test. They can take more than one attempt. They can take up to three attempts and what will be recorded in their course grade is just the highest score they get of all three, so they’re not afraid if they get a good score on the first one, they’re not afraid to take the second and third because the idea is I want them to do the spaced retrieval practice. That is, I want them to take many tests over a period of time giving a little bit of time in between. Letting them forget a little bit, do a test again, let them forget a little bit, by the time they get to the third test, they’re finding they’re really being able to pull that out of their memories very easily. That’s the retrieval part of spaced retrieval practice.
Kevin Patton: In that previous podcast I mentioned, I talk a little bit more about how I do these online tests that I make myself. Before I really get into that, though, I just want to mention that this is just one option and it’s an option that I took because at the time I started this, this was before there was wide availability of all of these wonderful tools that we have now, many of which are available from our textbook publishers. All the major textbook publishers have some type of online testing, adaptive learning tool, whatever they call it, where they’re going to be continually doing this spaced retrieval practice with the students. Those test items that are in there that are built into that, they’ve already been built and I would recommend that if you’re going to use those, that you go in and, as much as you’re able to depending on the platform, go in and make sure that it’s tailored to your particular course and your particular objectives and what you’re focusing on for your students, in your class, in that semester.
Kevin Patton: Back in the olden days, we didn’t have that available, so it was up to me. I knew that this would be a powerful tool and, as it turns out, it really had a huge impact on my students’ final exam scores. They were learning things much better and for a longer term than they ever were before. I am so glad. They felt less pressure because it was totally up to them in the olden days to learn this stuff. Then, I’d come in and test them using that summative, evaluative kind of test and say, “Okay, you should already know all this stuff and here, I’m going to test and see whether you do.”
Kevin Patton: I never really assigned them too many things that allowed them to do the practice without there being huge consequences for messing around. If they messed around, which is kind of our natural human tendency sometimes, they didn’t do so well on the tests all the time, but now they were starting to do it. Even those students who really weren’t good at studying because, well, they were studying by doing these online tests and they didn’t realize that that’s what they were doing. They were doing studying or what we called in the old days, homework when I mentioned last time, oh my gosh, there’s a lot of emotional baggage with that word, isn’t there?
Kevin Patton: When I tell them they have online tests and they’re open book and they can even consult with other students, they can consult with me, they can consult with tutors in the learning center, as long as they’re not getting the actual answers from them, that is, you know, number one is A, number two is B, number three is carbaminohemoglobin, as long as they’re not doing that, but just kind of bouncing ideas around and asking for explanations of ideas and concepts and so on, because they’re able to do that, they’re thinking, “Oh, my gosh. This Patton guy is so wonderful. Most of our tests are online, un-timed. I can do open book. I can ask other people to help me,” and so on. They’re thinking, “How easy is that?” Then, once they get going, they realize they’re spending a lot of time looking things up, learning things, relearning things, taking the next attempt, and so on. It eats up much more of their time because they’re actually forced to spend time on the course outside of class, but they don’t feel the pressure because hey, I’m getting away with something. I have an open book, online, un-timed test that I’m taking and isn’t this wonderful? It’s kind of a win/win in that regard.
Kevin Patton: I’m going to address some of the specific issues that come up, and I’ll tell you, like most things, I let this roll around in my brain for a long time and asked lots of questions, did lots of reading and kind of brain stormed with myself and with some of my colleagues. Kept pointing out, well, you know, if it’s open book and they really can ask each other, aren’t they all just going to create some big, huge, copy of the test bank and look up the answers that way? I finally concluded, let them. I mean, if that’s what they’re going to do, they’re still going to be practicing, they’re still going to be handling this information in some way.
Kevin Patton: I mentioned on my previous podcast that the way I set these up is in what some different systems, learning management systems have different names for these things, but they’re often called questions sets, randomized question sets, random sets, and so on. The way it works is let’s say item one on my test is about, oh, I don’t know, cell structure. Well, let’s say, it’s specifically about the fact that the cell will typically have a nucleus, surrounding cytoplasm, and a plasma membrane. That’s the concept I want to test. Well, for test one, I might actually, my test like have 15 different ways of asking that and some might be visual, some are verbal, and so on, because with online tests you can do that. You can put pictures in it and you can even put sound clips in it. Not that I have a sound clip of a nucleus, but I don’t know. Maybe someday we’ll be recording nuclear sounds and that will be important to us.
Kevin Patton: My point is, is that they can be a variety of different formats, styles, and content of those questions, so every time a student opens up a new attempt, they’re likely to get a different one of those 15 different possibilities. Even if they get the same one that they had in a previous attempt, when they get to questions two, the odds that they’re going to get the same one they’ve had before for number two, are really low, and the third, and the fourth, and the fifth. Now, there might be a few items that only have like three possibilities, so those might show up more frequently as repeats. Then, other randomized sets might have 25 items in it. Those are like hardly ever going to show up, any one individual one. It’s like winning the state lottery or something.
Kevin Patton: I sat down with a math professor when I first started doing this to try and figure out, okay, given my typical test, the number of items I have, the average number of items in each randomized set, and not only that, but the fact if it’s a multiple-choice question, you can randomize, or even a matching question, you can randomize the order in which the choices are given. We plugged that all into a computer. I remember sitting in the back of a faculty meeting where we were supposed to be paying attention to something else, but we were trying to work out what are the odds? The calculator that the math professor had couldn’t handle the answer. It gave us an error because the number was so high. That is the number of various iterations you could have of that test was so huge that the calculator couldn’t even handle it.
Kevin Patton: The odds that any group of students can be that well organized and spend that much time trying to reconstruct my test bank, well, let them do it because it’s not really going to happen and I do want them, when they take their first attempt, I want them to study that. I want them to learn what went wrong, what went right, and review it. Then, prepare for the second attempt. Then, they’ll take the second attempt. They’ll probably get a couple wrong at least there and then they can fix that because they’ll have been asked something in a different way or they’ll have been asked a slightly different aspect of something. I mean, you know how tests are. Right? I mean, we don’t ask every single fact that they need to know in the course. There’s no test long enough to be able to do that. At least, not in A&P. It’s always just kind of a sampling anyway, but they’re getting a different sampling every time. By the time they get to the third one, they have really practice this numerous times. They’ve really spent some time looking at where their weak areas area and trying to brush up on it. Then, by the time they get to the midterm or the final exam, they really have it embedded in their long-term memory rather than just learning it the night before.
Kevin Patton: That’s the thing about using space retrieval practice in general and this method in particular, whether you’re using your own homegrown, online testing system or that is built into learning management system, or you’re using that’s provided by the publisher, either way, you’re getting things into long-term memory. Not things that are being crammed in the week before, the day before, the night before, the hour before the test happened because we know that that just goes right back out of your … Well, no. It’s still in your brain somewhere, but when we’re very rarely able to retrieve it again because we haven’t practiced retrieving it.
Kevin Patton: Getting back to the nuts and the bolts of the way I did it, I did it in a learning management system. Now, I used a tool called Respondus, which is a standalone set of software that your school might already have a license for and they’re not all that expensive to get. It’s basically a test editor and the thing that’s neat about it is that when you construct your test in Respondus, so you put in the item, you put in choices, there are different formats that can be chosen and so on, you can change what Respondus calls the personality of your test. That is, you can change it from Canvas, which is the learning management system I use at one of my schools, at my community college or I can switch it do D2L, which is a learning management system I use at another one of my colleges that I teach at. If one of them decides to change to, I don’t know, to Blackboard or something like that, I can just switch the personality and it will convert all those items.
Kevin Patton: Now, if you’ve ever changed learning management systems, you know that sometimes things don’t translate a hundred percent, so what will happen is when I change the personality on a test I’ve saved, then it will generate a report and say, “Here’s the 12 items that could not be converted because that format doesn’t exist in the new learning management system,” or some other reason. I know where to go in there to either fix the item or to delete that item, maybe replace it with something else.
Kevin Patton: The next question I get … Okay, so the first question was, what about the open book part of it? Aren’t you afraid that they’re going to rely on their book? No, because students don’t want to look things up if they don’t have to and the more practice they do, the less looking up they have to do, so that’s okay. Sort of related to that is cheating. Yeah, there are ways to cheat, if you have somebody else take your test for you and that’s a problem with any kind of online learning. Right? I have a whole set of strategies for that that I’ll get into in another podcast. You can look through my blog. Some of it I’ve already published it in my A&P Professor Blog, but I’ll just leave one here because it’s very specific to online testing. That is do what the big security agencies do.
Kevin Patton: Did you ever notice that when they’re talking about security at an airport, they’ll say that well, there are other strategies that they won’t reveal at this time for security reasons. Well, of course not. If you lay out there exactly everything you’re doing to protect something, in this case protect the integrity of the test, then people are going to find ways around all of those if they have the whole list, but if you say, you know, I use a variety of techniques to monitor this and you’d be surprised at what I know about how you’re taking the test and what I can tell. That can be a deterrent.
Kevin Patton: Sort of linked with that is the idea that if you do catch someone cheating, then make sure that you announce that. Not say Joe or Jill over here, I caught them cheating and here’s how I caught them. Just say, this behavior was happening. We have ways of finding out that it’s happening. The student is in the process of being disciplined and you need to be careful that you don’t have this lapse in integrity yourself. You’d be surprising how effective that is and it’s not a lie.
Kevin Patton: There are things you can do that you don’t necessarily want to reveal. There are timestamps. I caught a cheater one time who is in my class and I remember her being in my class while her boyfriend was over in the library taking her test for her, which was a bad move in a variety of ways. Probably the worst of which was that he did even worse than she did when she took her own test, so she was trying to up her course grade by having somebody else who wasn’t even in the class and had never taken the class do her test. Not a good move, but that’s how I caught her was looking at the timestamps and I also got a tip from one of the librarians that said, “Hey, I think something funny’s going on with this student. You might want to check it out.” I have spies, a network of spies out there that are watching this stuff. It really is kind of hard to cheat on my tests because it is open book and you really would have to recruit somebody else to take your test to be a cheater on the online tests. Now, the in-class tests, that’s a whole other ball of wax, isn’t it?
Kevin Patton: Getting back to this idea of students helping one another, a lot of my colleagues say well, aren’t you afraid that they’re going to help one another? No, I want them to collaborate. Collaborative learning is a great way to learn. When they’re out there in their various clinical fields, aren’t they going to be consulting with each other? Do I want a nurse taking care of me who’s afraid to ask another nurse how something is done or can they help them refresh this because it’s been awhile since they did this particular procedure or gave that particular kind of medicine or treatment or whatever? No. I want them to develop those skills of doing it. I don’t want them to necessarily get the answers from somebody, but I want them to talk through the answers with other people. That would be great. It’s a great learning experience.
Kevin Patton: Some colleagues ask, well aren’t you afraid that your students are going to print out their tests and pass them along to other students? Nope. I’m not afraid of that either because then that just gives them more practice, more opportunities to look at the test and see what kinds of things I’m going to be asking, how I’m going to be asking them, and so on. Maybe they can help each other figure out what went wrong on the items that they got wrong. This is all automatically graded, so that means that this is all going on behind the scenes without me taking a lot of time to do it or any time to do it really, except kind of monitoring what’s going on. They get lots and lots and lots of practice by doing this.
Kevin Patton: Now, the big question that I’ve saved for the end is doesn’t this take a long time to build such a big test bank? The answer is it takes about a year. What I did was I just decided I’m going to jump in with both feet and so in A&P One in the fall, this is many years ago now, I just went in and I just stayed one test ahead of them. Every evening, when I was done with the rest of my work for the day, I would sit down and spend 20 minutes, a half hour, just typing up test items. It’s like anything, once you just finally do it, you start to get the hang of it. You start to get a feel for what makes good questions and what doesn’t. I mean, you probably already have some of that, right, from writing tests anyway, but this is really going fine tune those test item writing skills, I’ll tell you that. You get fast at it and you figure out good ways of changing items around so they’re not the same item, but still asking about the same content. Playing around with different formats and so on.
Kevin Patton: Pretty soon, I was going faster and faster and faster. By the time I got to the end of A&P Two, it wasn’t such a chore anymore and anyway, I was close to being done. Then, every year after that, I would go in again and just pull out the questions that I knew were not well-worded. How did I know that? Because I get statistics. That’s another beauty of these learning management systems, they tell you what the hard questions are and you can look at them and see. Is that a hard question just because it’s a hard concept to wrestle with? If so, then maybe I’ll leave it in there or maybe I’ll just change a little bit or is it a hard question because it’s so confusing and people are going to put the wrong answer because they misinterpreted what I was asking? I can pull those out or change them.
Kevin Patton: Then, of course, there’s always the opportunity to add more to those random question sets, so the question set that had only five items in the first time around, now I can bump that up to 10. Have 10 different version of that question go through. I’m always tweaking them, always editing them and so on, but once you get through that first year, it’s easy and actually halfway through that first year, it’s not as bad as it sounds. Yeah, it does take time and you can stretch it out longer if you want, but the big trick is just doing the first one. It’s like doing this podcast, it took me forever to start doing it and now that I’m doing it, it’s not so bad. It’s actually kind of fun. I hope you’re having fun, too.
Aileen: The A&P Professor is hosted by Kevin Patton, professor, blogger, and textbook author in human anatomy and physiology. Please do not use any of these suggestions you heard in this podcast if you are allergic to them.
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