The increased enrolments of students at HEIs have necessitated the development and use of appropriate teaching, assessment and feedback methods to promote engagement and critical thinking to ensure that students achieve the stated learning outcomes of each module. Such activities should also be efficient in terms of its use of available time and human resources. The use of posters as a teaching, assessment and feedback strategy is relatively new in the MBChB program at UKZN, and is currently only used in the MaD and Selective 02 modules. Posters have however been used extensively with psychology and nursing students, and have been shown to promote collaboration and enjoyment in learning about research.(18) Researchers also report that the educational use of posters increases students’ enjoyment of the learning process, helps create a positive learning environment, and assists with consolidation of their new knowledge, which greatly adds to their confidence to discuss research related topics.(18)
A key challenge in teaching large classes is to promote deep learning, and for the students to actively engage with the learning material. The poster preparation and presentation required students to analyse their experiences, obtain feedback from participants, and evaluate the impact of the MaD: group community service activity on themselves and those with whom they had worked. Students reported that this form of assessment promoted active engagement with the learning material, as they had to select important aspects from their interaction with participants at their MaD sites to demonstrate how they had understood ‘disadvantage’; made a difference in the community; engaged with the community around issues of HIV and how they had learnt from the people at the site. The posters also promoted learning and active engagement, as the students organised their thoughts through the rich learning context provided at their MaD sites, which promoted higher order thinking skills and deep learning. (19) The majority of staff members (90%) indicated that the poster presentation had allowed students to demonstrate their engagement in a meaningful and appropriate way around issues of disadvantage and HIV, as well as how they learnt from others. The posters therefore allowed students to present to the assessors and their peers how their hands-on experiences at their service sites had culminated into new learning.
All the students and staff members indicated that the poster presentation allowed students to demonstrate how they had made a difference in the MaD community to which they had been allocated. This is an important transformative outcome, as students needed to feel and experience that they can make a difference, even at 1st year level, without having to wait until they qualified to contribute in their chosen community. Brooks et al (2018) highlighted that student transformative learning experiences are enhanced when they feel that they are making a significant difference and are able to contribute to medical citizenship.(20) Coria et al (2013) drew attention to the fact that assignments that ensure students confront real issues relating to social justice should be included in medical school curriculum, as an increasing number of medical students want to find ways to decrease health disparities and are willing to work with underserved people.(21)
Learning to collaborate and learn in teams is a key competency for health care professionals (HCP) to attain and an important core outcome competency, as specified by the Health Professions Council of South Africa (HPCSA).(22) Designing assignments that promote students’ collaborative leaning in teams is therefore an important outcome on the MBChB teaching platform, which should be assessed at various intervals during the 6-year programme. With increased polarisation of the South African society, there is a tendency among students to prefer to work in homogenous groups. However, due to their being assigned to racially and culturally diverse groups, they were encouraged to interact and learn about one another, and to work together in preparing and presenting their posters as an outcome of this module. Most of students (89%; 201) indicated that working in groups had helped them to learn more than they would have learnt if they had worked alone. In addition, 93% (211) indicated that the poster preparation and presentation encouraged interaction within the group. Researchers in other contexts have similarly recognised the value of posters to promote team work and learning from one another.(18, 23) Mellor identified group work as a way of supporting effective student learning,(16) and highlighted that working in groups promotes collaboration and socialisation(16) as they share their ideas, clarify differences, and develop conflict management skills through interaction with others.(8, 16)
Effective communication is another essential skill for HCPs to demonstrate,(24) with most (77%; 175) students reporting that the posters presentation had introduced them to a new way to share information with others. Other researchers have reported that poster presentations provide an excellent medium for developing communication skills and reflective thinking, and provides an opportunity for peer learning.(18, 25) Spiller highlighted the importance of clearly communicating the assessment requirements, methods and learning outcomes to students to ensure that learning is effective.(11, 26) When asked, 100% of staff indicated that the marking rubric provided consistency in the marking, and 75% of the students considered that the poster presentations, as a means of assessment to be fair to all students. However, only 60% of the staff indicated that it was fair to give the same mark to all members of the group, as it may not reflect the amount of work done by each person.
All the staff members indicated that marking the poster presentations in this multiple-reviewer context was quicker and more efficient than marking written assignments. The poster presentation ensured that all the marking was completed in one morning, allowed for immediate feedback, and for staff to validate student participation in the MaD group community service activity, which would not have been possible if they were marking a written assignment.
All staff members reported that probing questions at the poster presentation about the meaning of disadvantage, how students made a difference and how they learnt from participants at the sites proved to be an effective way of validating that students had participated in the activity. However, only 76% of students indicated that the poster presentation validated their participation, which may have been because it was a group activity, and not all members may have participated equally. Plagiarism is a growing problem at all universities and a number of proactive and punitive mechanisms have been put in place at NRMSM and other universities around the world to ensure that students submit their own work and to combat plagiarism.(27) The poster presentations provided an easy and low-tech mechanism of validating student participation at their community site. More research is needed to find effective proactive ways to combat plagiarism and to ensure students participate and submit their own work.
Providing timely feedback is an important way to promote learning and engagement with the learning material.(15, 28) Feedback is said to develop self-awareness as students answer the following questions: ‘How am I doing?’ and ‘How can I get better?’. However, providing constructive feedback that is timely, meaningful, specific, effective, relevant to the current needs of the learner and gives suggestions to improve their learning (28) is difficult to provide in the large class context as well as when marking a large number of assignments, with students rarely getting adequate feedback. Most students (87%; 144) and staff (90%) agreed that the poster presentations allowed for immediate and effective feedback to groups about their presentation and the activities during the MaD group community service activity. It is important, even in large classes to find effective ways to give appropriate feedback to students to encourage their deep and meaningful engagement with the learning material. This is an area that requires more research to find effective ways to provide feedback to large student groups enrolled at HEIs.
Although only 1.1% (26/ 230) of students wanted an alternative form of assessment, most students and staff were positive about the use of posters as a means of teaching, assessment and providing feedback. The alternatives suggested, such as power point presentations, would have taken more time to prepare and need additional logistical support. Site visits and direct feedback from the organisation have been built into student assessment in other countries, notably in the decentralized medical education in the Philippines.(29) Although this method of assessment is very effective in validating student experiences and evaluating the evidence of transformation in the communities, the site visit can be time consuming, costly and difficult to implement in a large class setting.