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close this bookTeaching for Better Learning (WHO, 1992, 197 p.)
close this folderPart 3: Finding out how much your students have learned
View the documentCHAPTER 11: General issues in assessment
View the documentCHAPTER 12: Assessment methods

CHAPTER 11: General issues in assessment

One of the most important parts of the teacher's job is to find out how much students have learned. This process is called assessment. It can be carried out by setting examinations or watching students at work. This chapter covers the general issues and problems related to specific methods of assessment.

11.1 Why must students be assessed?

Most teachers agree that students should take some kind of examination or that students' ability should be measured in some way. In other words, students should be assessed.

It is important to assess students because:

1. Teachers need to make sure that the students will be able to do the job competently. This is especially important in all the health professions.

2. Examinations and tests encourage students to work harder.

3. Assessments can be used to guide teachers and students about which parts of the course have been successful and which parts need to be improved.

Naturally no single assessment during the course can achieve all these objectives. For example, a final examination may be good for seeing whether students are able to do the job. But it will not be much use in guiding students about what they should learn.

It is important to think about the reason why you are assessing students in any test or examination. Then you can design the test accordingly. You need to decide who will do the assessing, when it will be done, and what kinds of questions you will use.

11.2 What makes a good assessment?

When you design the assessment methods for a course or lesson, there are five questions that you need to consider.

1. Does the assessment comply with the regulations for the course? 2. Is the assessment reasonably economical in terms of materials and time?

3. Does the assessment test the important skills and abilities? (Is the method valid?)

4. Are you sure that the marks gained by each student are accurate? (Is the marking reliable?)

5. Does the assessment give information that will help the students to learn better and help you to improve your teaching?

The first two points are fairly straightforward. Sometimes there are regulations about the kinds of examinations that must be used. These regulations must be observed, but often the regulations only concern the final examinations and allow teachers to choose which methods of assessment to use during the course. If you feel that the regulations prevent you assessing the students in a satisfactory way, talk to other teachers and the people responsible for making the regulations. They may decide that the regulations need to be changed.
Assessments must not involve too much time and effort. Methods such as oral examinations and essays have disadvantages because they take up so much of the teachers' and examiners' time.

The remaining questions are discussed in Sections 11.3-11.5.

11.3 Making sure that the assessment tests the important skills and abilities

After some recent anatomy and physiology examinations in a medical school, a senior clinician said "I could not answer the questions, nor could any of the other doctors who read the examination paper. I could not understand why the students needed to know these things."

This case highlights a serious problem that can occur in any schools that train health workers - students are often asked about facts that are not important.

This problem is serious because students naturally want to do well in examinations and so they learn what they think will be in the examination. The solution is to test only those skills and abilities that you believe are important.

If the learning objectives have been derived properly, then all the learning objectives will be important. Therefore the assessment should test directly whether the learning objectives have been achieved. If this is done, then the assessment will test the important skills and abilities. When this happens, the assessment is said to be valid.

Sometimes examinations focus mainly on knowledge and tend to ignore the performance of students. This is bad. For example, consider one of the tasks of health educators - "persuade mothers to breast-feed their babies". In a bad examination, health educators might be asked to write essays on the nutritional value of breast milk. This assessment would only test a few of the skills needed (it does not cover the skills of talking to mothers) and so it is not valid.

It is easy to advise teachers to make examinations valid by testing the performance of their students. It is much more difficult for the teachers to plan assessments that will do this. Some ideas are given in Chapter 12.

11.4 Making assessment reliable

In a recent examination, the students were asked to write an essay about the treatment of burns. The papers were marked by the teacher who had taught the course. Then another teacher marked the same examination papers. The scores given by the two teachers were very different. For example, one student was given 45% by one teacher (a fail) and 70% by the other.

This demonstrates that in this examination the marking was not reliable.

Clearly, the final mark should be reliable or it becomes meaningless. How can you be sure that a mark is reliable? The answer is to try to cut out the errors involved in the assessment process. Use assessment methods that are less likely to lead to errors. (For example, the marking of multiple-choice questions is more reliable than that of essays.)

You should also use techniques that help the people marking the examination to work to a uniform standard. These methods are described in more detail in Chapter 12.

11.5 Using assessment to help students to learn

Tests and examinations can encourage students to do more work - and so they help them to learn. However, assessment can also show students exactly what they need to spend more time on. In many courses the teachers give frequent tests and then tell the students what exactly they have done badly. In this way students get feedback about the quality of their work and can improve their performance.

To illustrate this point, look at the results for five students who took a 4-part test in the middle of a course.

Exercise: Using assessment to help students to learn


Part 1

Part 2

Part 3

Part 4


























V - satisfactory standard
x - unsatisfactory standard.

What would you do if you were the teacher?


Probably you would be satisfied with Part 1. For Part 2, you should advise student A that his standard was not good enough. You should explain why the work was not good and how it could be made better. Ideally the student should be tested again on this part at a later date.

The results for Part 3 show that only one student reached a satisfactory standard. Probably this part needs to be taught again. Here the teacher gets feedback about his or her own performance - so perhaps next year the topic will be taught differently.

Part 4 shows that two students need more guidance. However, it would probably be a waste of time to repeat Part 4 for the whole class.

If you do everything suggested in the comments above, you will find that it will take you a lot of time to assess students. This is a problem, but giving students this kind of individual guidance is one of the most valuable things that a teacher can do. You must try to make time. One way is to spend less time lecturing to the class and instead to let students learn directly from manuals, handouts and practical experience.

Note that this frequent testing and guidance applies equally well to both the knowledge and the skills that need to be learned.

11.6 Continuous assessment

In some courses, students sit one final examination at the end of the course. In other courses, students work under constant supervision. Between these two extremes, there are courses with tests or assessments every week, month or term. This type of assessment is usually called "continuous assessment", although "frequent assessment" would be a more accurate description.

What are the advantages of continuous assessment?

· Because there are several assessments, an error in any one assessment is less important. Continuous assessment tends to be more reliable.

· The tensions and worries of the single final examination are reduced.

· Because students are assessed throughout the course, they tend to work harder during the course instead of making a single desperate effort at the end.

· If students do poorly in one test, they have time to correct their errors before the end of the course. Continuous assessment gives more guidance to both teachers and students.

· Students are shown throughout the course what standard is expected.

The tensions and worries of a single final examination.

Of course there are some disadvantages as well. The main disadvantage is that continuous assessment takes more time and effort for teachers to organize.

Continuous assessment can take many forms. It may be a series of written tests. It may involve observation of students while they are working on a ward, in the laboratory or in the field. The marks given may be recorded to decide whether students eventually pass or fail. Or the marks may be used only to guide students. Whatever system is followed, continuous assessment offers important advantages both in helping students to learn and in making more accurate and reliable judgements about how much they have learned.

11.7 Self-assessment

Self-assessment is the name given to assessment where students assess their own performance.

Some teachers are very worried by this idea because they feel that students are not responsible enough or do not know enough. This is probably true at the beginning of the course. However, some health workers will be working with very little supervision after they have qualified. So in the job they must assess themselves. Therefore it is a good idea to give the students some experience of self-assessment while they are still being trained.

Naturally self-assessment is a method that is used for only part of the time. Teachers or external examiners will be used to decide whether students should pass or fail at the end of a course. However, self-assessment can be used during the course. It will help to save time and give students a greater sense of responsibility.

In self-assessment, students need clear guidance about what standards are required. They must also be given a very clear idea of the task. For example, you might ask students to:

1. Inspect 50 microscope slides of blood samples to determine whether malaria parasites are present.

2. Fill in standard forms for stock control in a pharmacy.

3. Plot a patient's temperature on a chart.

4. Weigh and record the approximate weight of a baby.

In all these examples, the students can compare their own work with a correct answer and so learn whether their work is satisfactory. Note that cheating is not a problem, because the purpose of self assessment is to learn not to score points in an examination.

11.8 Peer-assessment

An alternative to self-assessment is peer-assessment. This is the name given to assessment where students assess each other.

This method is not suitable for deciding whether students pass or fail at the end of a course. But it is a very good method for helping students to learn.

Many students ask a friend to test them when they are revising for an examination. This practice can be encouraged and guided by the teacher. For example, you could give the students written instructions for doing a job. Then one of the students attempts to do the job, while the other one watches and comments. The students then change over and the second student does the job watched by the first one.

You must of course provide the written instructions. These can be prepared either from your own experience or from a manual.

Peer-assessment can help to make field experience have more meaning and relevance for students. Instead of vaguely trying to do a job as well as possible, each student will be supervised by a fellow student who is there to watch and advise.

"Then one of the students attempts to do the lob...".

11.9 Summary

Look at the three examples of assessment methods given below. Then comment on them using some of the points made in Section 11.2:

- Is the assessment economical in terms of materials and time?
- Does the assessment test the important skills and abilities? (Is it valid?)
- Are the marks accurate (reliable)?
- Does the assessment help students to learn?

Now look at the following examples.

A. At the end of the course, a written examination is held in which the students have to write four essays in 3 hours. Then an external examiner meets all the students individually for 15 minutes to give them an oral examination on what they have learned.

B. Every 2 weeks during the course, students have to answer 20 multiple-choice questions on topics such as signs and symptoms of diseases, methods of treatment, and prevention of disease. The students mark the papers themselves by comparing the answers with the correct answers supplied by the teacher.

C. Trainee community health nurses (CHNs) spend 1 month working with an experienced CHN (two students work with each CHN). The students do most of the work themselves under supervision. The supervisor then writes a report on the students.

Write down your comments on each assessment method.



Economy of time



Helping learning







Good after 1st year

Misses many important skills

Very good




Very good



A. This method is bad in almost every way. It will take a long time to mark the essays and to conduct the oral examinations. Students will not have to write essays or talk to external examiners after the course - so the skills tested are not important. Essay-marking and marks given in oral examinations are frequently not reliable. The timing of the examination also means that students will not learn much from it.

B. It will take a lot of time to set the multiple-choice questions. But the questions can be used year after year (with a few changes) and they are very quick to mark. The assessment may test important skills, depending on the exact questions asked and what work the students are being trained to do. However, multiple-choice questions usually only test factual knowledge, so they cannot test many of the important skills that should be tested. The reliability is excellent - there should be very few marking errors. Students should learn both from marking each other's work and from seeing exactly what errors they have made. But note that it will only help them to learn factual knowledge

C. This method will take quite a lot of time because the supervisor writes individual reports. However, the important skills are being tested. The reliability may be low because different supervisors may have different standards. The assessment should help learning very effectively.

These examples illustrate that each assessment method has some disadvantages. You should be aware of these problems and try to reduce them as far as possible. Specific guidance on different assessment methods is given in Chapter 12.