The Actual Effects of Examinations on Medical Student Learning

ABSTRACT Some research findings support the notion that student learning is largely inflienced by the examinations being taken. Other work suggests the situation is more complex. This paper focuses on the kind of learning needed in medical education and the conditions necessary for its generation, arguing that once this is clarified the influence of examinations can then be explored. Cognitive psychology suggests that efficient retrieval of knowledge requires storing information about the retrieval setting along with the facts to be remembered, and that retrieval in novel settings is more likely when cognitive structures are substantially interconnected. This paper presents evidence showing that medical students can develop this kind of learning, called here elaboration, but only under particular curricular conditions, notably when they see their task as one of relating abstract information and concrete experiences. Elaborated learning occurs even when the examination arrangement is traditional. It is concluded that students fail to learn appropriately because the necessary curricular conditions are not met, not because of the examination arrangements. Educational planners need to take a whole curriculum view, and cannot expect appropriate learning to be generated merely by changing the examination arrangements.