education learning physiotherapy teaching

Ranking students, or developing understanding?

We have a collection of courses at my institution that have become known as “killer courses”. These are the courses with a history of poor student performance in terms of throughput and retention, and which we’re trying to provide extra support for. Two of these killer courses are outside courses (i.e. outside of our department) but which are nonetheless requirements for our students to pass. Traditionally, it’s a struggle for many students to get through these modules and we’re still not sure why. The institution is investigating the issue and one of the suggestions has been to provide tutorials, for which additional funding has been provided. The problem is that students don’t attend the tutorials. Either they don’t see the value or don’t believe that they need the extra assistance. Whatever the reason is, our students (and students from other departments who are required to pass the courses) don’t attend the tutorials.

I believe that the reason the students don’t attend is because the tutorials aren’t graded, and I believe that that is part of the problem. Don’t get me wrong, I’m not suggesting that I think the tutorials should be graded. On the contrary, I think we need a system with fewer graded modules. The problem is that students assign value to material that is assessed through being marked, with us as the all-knowing teachers with all the right answers. As clinical educators, we have developed (or are at least part of) a system in which assigning grades is the one way that we tell students what we think is important. From the students’ perspective, if it’s not for marks, then it can’t be important.

I spoke to our 3rd year class a few months ago and suggested that they work towards a deeper understanding of material, rather than working towards getting an increase in marks. This was greeted with confusion by the students. At the end of the day they pass or fail based on their ability to accumulate marks (by the way, the 50% pass mark, or cut score, is largely arbitrary and irrelevant). They told me that we rank them by grade, rather than capability, so how can I say that understanding is important, when we place all the value on marks. I tried to argue that an emphasis on understanding will lead to higher marks, but then I realised that we don’t evaluate for understanding (there are many reasons why teaching and evaluating understanding is Hard). Many of the assessments of these students are about their ability to memorise content and patterns of movement, which is easier for them to do than to really understand the concepts. In order for us to push the understanding agenda, we will need to change how we teach and how we assess.

Once these students graduate they will never again be assessed on their professional competency with marks. This is one of the great disconnects between physiotherapy education and real-world physiotherapy practice. In the educational context, we rank students by grades based on their ability to reproduce the things that we say are important. In the real-world, there’s no-one telling them what is important, no ranking, no grades, no tests, etc. The only indicator that has value in your profession is whether or not your patients’ quality of life goes up as a result of your intervention.

I don’t think that the solution to getting students to attend tutorials is in making them mandatory, or to grade them. I think we need to help students shift the emphasis of their studies from scoring higher marks,  towards actually understanding the concepts and ideas we’re working on. We really need to emphasise that higher marks doesn’t necessarily mean better understanding. But, in order to do that, we need to shift our teaching culture from placing such a high value on marks, and move towards emphasising the importance of deeper understanding. And not making the mistake of thinking that one is the same as the other.

By Michael Rowe

I'm a lecturer in the Department of Physiotherapy at the University of the Western Cape in Cape Town, South Africa. I'm interested in technology, education and healthcare and look for places where these things meet.