A Neuroanatomy Lab Practical Exam Format in Alignment with the Universal Design for Learning Framework

There are separate poster presentation times for odd and even posters.
Odd poster #s – first hour
Even poster #s – second hour

Abstract Body : The traditional format for an objective structured practical examination (OSPE) involves stations with a time limit for each station and inability to revisit stations. Timed exams have been associated with anxiety, which can lead to poor academic performance. In alignment with the Universal Design for Learning (UDL) framework, two additional OSPE formats, ‘Timed Question per Slide’ and ‘Untimed Question’, were designed to determine which format supports student success, especially for those who performed poorly in the traditional format. The Universal Design for Learning is a framework based on cognitive neuroscience that proposes to engage multiple brain networks to optimize teaching and learning for all students. In ‘Timed Question per Slide’ format, students viewed slides with images of specimens and their corresponding questions with a time limit per slide. Students were not allowed to revisit a slide. ‘Untimed Question’ did not have a time limit per question, and students were able to revisit questions. All three OSPE formats were administered in a randomized order within a course for three cohorts of second-year medical students. When all students’ scores were analyzed together, the type of format or cohort year had no effect. However, when analyses were conducted only on students earned below an ‘A’ in the traditional format, the type of format, but not cohort year, had an effect (Fig. 2a and Table 2; F2, 126 = 9.20, p< 0.01, for type of format; F2, 126 = 0.59 for cohort year; two-way ANOVA; n = 45). Post-hoc analysis showed that ‘Below A’ students in two cohorts performed significantly better in the ‘Untimed Question’ format compared to the traditional format (p < 0.05, Tukey’s multiple comparison test with correction). Eighty-seven percent of ‘Below A’ students increased their score, on average, by at least one grade level in the ‘Untimed Question’ format compared to the traditional format. In contrast, 83% - 86% percent of the students who performed well in the traditional format maintained their ‘A’s, on average, in the two new formats. The distribution of students’ most preferred OSPE format amongst all three formats were different before vs. after experiencing all three formats (Fig. 3a; χ 2(2) = 8.18, p < 0.05, Chi-square test). The percent of student who indicated ‘Untimed Question’ as their most preferred format increased from 60% to 78% after taking exams in all three formats. The distribution of students who associated 3 features of the traditional OPSE: 1) time limit per question, 2) moving stations, and 3) inability to return to a question with either ‘none to low’, ‘neutral’, or ‘mid to high’ levels of anxiety were significantly different from each other (Fig. 4; χ 2(4) = 13.95, p < 0.01, Chi-square test). Sixty percent of students associated the inability to revisit a question with mid to high levels of anxiety, while 39% associated the time limit per question with mid to high levels of anxiety. A neuroanatomy lab exam format was therefore identified as consistent with the UDL framework such that all students, regardless of test anxiety levels, can equally demonstrate what they learned. This format allowed for unlimited time per question and the ability to revisit questions. This study showed that the UDL framework can be successfully applied to the assessment environment of an anatomy course. Further studies on the impact of the UDL framework on the academic performance and anxiety levels of all anatomy students are needed to keep students engaged in anatomy education.