The increased enrolments of students at HEIs have necessitated the development and use of appropriate teaching, assessment and feedback strategies 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 their use of available time and human resources. The use of posters as a teaching, assessment and feedback strategy is relatively new in the MBChB programme at UKZN. 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) Such as reported in our study, researchers have similarly found 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. These factors greatly add to the confidence and motivation of the students to discuss research related topics.(26)
A key challenge in teaching large classes is to promote deep learning, and to motivate 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 on those with whom they had worked. For students this form of assessment, promoted active engagement as they selected important experiences from their interaction with participants to demonstrate how they had understood ‘disadvantage’; had 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. Having to synthesise information for the poster thus promoted learning and active engagement as it challenged students to organise their learning experiences in a meaningful way to describe the benefits thereof. This promoted higher order thinking skills and deep learning. (27)
Most 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. Students also shared how they had learnt from their peers and others in the MAD community. The posters therefore allowed students to present to the assessors and their peers how their hands-on experiences at the service sites had culminated into new insights, transformational experiences and new learning.
All the students and staff members indicated that the poster presentation allowed students to demonstrate how they had made a difference in their selected MaD community. This is an important transformative outcome. First- year students needed to discover new insights about their ability to contribute meaningfully to a chosen community and that they did not have to wait until they were qualified as a medical practitioner to do so. Brooks et al. (2018) highlighted that students’ transformative learning experiences are enhanced when they feel that they are making a significant difference and are able to contribute to medical citizenship.(28) 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 the 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.(29)
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).(30) Designing assignments that promote students’ collaborative leaning in teams is therefore an important outcome on the MBChB curriculum that are 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 the requirement for students to work in racially and culturally diverse groups on this task, they are encouraged to interact and learn about one another, and to work together in preparing and presenting their posters. Most 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 had 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.(26, 31) Mellor identified group work as a way of supporting effective student learning,(23) and highlighted benefits such as collaboration and socialisation(23) as they share their ideas, clarify differences, and develop conflict management skills that are develop during group interactions.(13, 23)
Effective communication is another essential skill for HCPs to demonstrate. (32) This activity provided a safe and supportive setting for students to present their work on the MBChB (95%: 213). For most of the 1st year students (77%; 175) the poster presentation had introduced a new way to share information with others. Other researchers similarly reported the benefit of poster presentations as an excellent forum to develop communication and reflective thinking skills and opportunities for peer learning.(26, 32) Spiller highlighted the importance of clearly communicating the assessment requirements, methods and learning outcomes to students to ensure that learning is effective.(17, 34) When asked, 100% of the staff assessors 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 adequately discriminate between the contributions of each group member.
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 a period of 4 hours, 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. Based on staff experiences in marking other written assignments in the same module, we estimated that it would have taken twice as long for two members of staff to mark each formal written group submission. In addition, a written assignment would have offered fewer opportunities to ask clarifying questions to validate the experience and therefore limit the feedback to the group.
All members of staff reported that probing questions posed to students about the meaning of disadvantage, how students had made a difference and had learnt from participants proved to be an effective way of validating the degree of the students’ involvement 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 to counter on written assignments and a number of proactive and punitive mechanisms have been put in place at universities to ensure that students submit their own work and to combat plagiarism.(35) 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.(21,36) 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 (36) 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 area 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.(37) 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.
This case study was conducted with one cohort of MaD students at a medical school in a resource limited environment. Educators at other settings will have to compare our description of the setting and problem to assess the applicability of our results to their settings. However, the participation rate was very high, with the results being a good reflection of the student and staff perceptions at NRMSM of the use of posters for teaching, assessment and feedback.