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Yuan-Ling Ng, UCL Eastman Dental Institute/Medical Science, shares how they overcame the challenge of assessing students鈥� clinical diagnostic and treatment planning skills online during Covid-19.

Yuan-Ling Ng,听Programme Director,听Endodontology听(UCL Eastman Dental Institute/Medical Science), describes how Endodontics students鈥櫶齝linical diagnostic and treatment planning skills听were assessed online using听BlackBoard听Collaborate and Moodle.听听

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Using vivas to test clinical diagnostic and treatment planning skills

Students on听Clinical Postgraduate Taught Programmes (MSc or听MClinDent)听are听assessed on cognitive aspects of听the听clinical diagnosis听process, treatment options appraisal, and treatment planning听skills;听as well as on their practical insight of the related treatment procedures.听听听

Ordinarily, we would assess students鈥� clinical diagnostic and treatment planning skills using actual clinical cases, in person.听听We deliberately omit some critical information from the patient history and examination findings in the case summary from which the students synthesise a picture of the case, so as to assess their ability to identify missing critical data; our explorations can then focus on how they might acquire the missing information to aid their diagnosis and treatment planning.听

In these extraordinary times, we were forced to rethink our approach as face-to-face assessments were prohibited during the Covid-19 lockdown; it wasn't possible to assess communication skills in the face-to-face interaction that would normally occur with patients.

We set about finding a means of听online assessment of simulated听clinical cases, in place of our real clinical cases听-听 one听which allowed us to assess students鈥櫶齛bility听to critically weigh available, and relayed information听so as to听guide the patient to provide the relevant facts for a diagnosis.听

Our solution

In coming up with our听approach听to online assessment of clinical skills, we were mindful of several challenges we needed to overcome:听听

1. We needed to听ensure the assessment remit and standard are fulfilled, but we also wanted to听streamline the process as per face-to-face examination format:听听

• candidate to view the simulated case听- a summary of presenting conditions plus听clinical and radiographic images听-听under听invigilation;听听

• examiners signing into听the session to start the viva听promptly;听听and听

• sufficient time for the invigilator to start the case viewing by the next candidate.听听

厂辞濒耻迟颈辞苍:听The functions of the 听- UCL's online conferencing and online classroom platform -听met with our needs and we听conducted听repeated trials听of our process and technology听to ensure it was streamlined.听

We听included听a 鈥渢ransition time鈥澨齣n the examination schedule听so听examiners and invigilators听were given enough time听to move between candidates.听听

2. We wanted to听ensure the simulated case examination material听can be uploaded听by the administrator to听all candidate sessions听in advance,听without leaking to the candidates.听听

厂辞濒耻迟颈辞苍:听We used the 听to limit access by students until the appropriate time.听听

3. We had to ensure听pre-agreed and consented video-recording听could be听saved securely in Moodle听for internal/external examiners and quality assurance purposes, without giving听access听to all听candidates.听

Solution:听听The format was piloted to ensure there was听sufficient bandwidth and that audio and video devices were compatible with the platform.听听

We used the 鈥淎ccess Restriction鈥� function again by changing the access restriction from 鈥渋ndividual student鈥� to 鈥渆xaminer group鈥� immediately after each examination.听听

Other platforms not integrated with Moodle, e.g. MS Teams, would require the administrator to immediately download and delete the video from the platform to prevent candidate access.听听This process requires听some time and consideration听and听it may require听an additional staff member to assist the exam process.听听

To ensure no illegal intrusion to the sessions, this approach only allows candidates to access the session via UCL Moodle,听and the examiners were given the link via their UCL e-mail address.听听听

Our solution听allowed maintenance of the examination remit and standard of assessment, despite a change of format and approach, and听the Blackboard collaborate meeting platform is available within听Moodle, which ensures听secure storage of examination materials.听听

Download our step-by-step guide to creating unseen vivas in Moodle and Blackboard Collaborate

This approach was a first for the UCL Eastman Dental Institute. I got the inspiration after reviewing the functionality of the online meeting platform,听, during our Departmental Teaching Committee meetings. I gained experience by chairing virtual seminars with students via Skype for face-to-face discussion, and using the听听鈥渃lass notebook鈥� function for summarising the discussion.

Timeline and resourcing听

The project started in April 2020 after the Covid-19 assessment amendments were approved by UCL.听We carried out the听first test and mock听Vivas听on 30 April 2020.听听

We settled on the听final protocol for set-up,听after multiple testing听rounds, on听20听May 2020听-听the actual examinations were successfully completed on the 2nd听June 2020.听听

We made refinements to the set-up to听improve security and streamline the transition from candidate to candidate,听as well as candidates鈥櫶齰iewing of case material.听听

I led听the project with support by the Deputy Programme Director听and Programme Administrator to complete initial trial.听听

Three听internal examiners听were involved听in two mock听Vivas听per candidate听(n=13) and听provided听feedback for refining the set-up.听听

The total听resourcing听can be estimated to 130 hours before the process听was听implemented for the summative assessment.听

Staff and student response

The staff and students were well prepared for the actual online examinations. We were able to test the students鈥� clinical skills without being affected by the lack of face-to-face contact and IT issues.听听

We sought feedback from both staff and students with a view to enhance their experience.听

The feedback听was听positive and constructive:听听

Student feedback

鈥�Just wished to give feedback regarding the mock viva set up today- I thought it worked well and had no issues viewing the case. I think the format on Blackboard is very good. - Student

鈥�Learning via the blackboard collaborative has been on par with face-to-face teaching for seminars and case-based discussions. Furthermore, the mock viva sessions were important to highlight and address any technical issues before the exam. Preparing for and undertaking the unseen clinical case viva has helped me to enhance my diagnostic skills. The process ensures that you evaluate the bigger picture before focussing on the individual tooth-specific problems. It also helps to improve decision-making skills and enhances the application of knowledge so that it is tailored to the听particular case / problem听at hand. Furthermore, the process of speaking out loud when practicing in a group over blackboard sessions has helped to improve confidence for the actual examination and has highlighted deficiencies which can subsequently be improved upon鈥�. -听听Student,听 Dipita听Moorjani, BDS MFDS Edin. (MClinDent听Endodontics)听

鈥�Blackboard Collaborative has facilitated our learning greatly at a time when face-to-face teaching is not possible. It is an excellent platform which has enabled case-based discussions, seminars and meetings to be held without any interruption or technical difficulty. The recent oral exam went very smoothly through Blackboard Collaborative and was no different to a face-to-face viva. Two mock exams were also undertaken through this digital platform, providing the opportunity to simulate the exam conditions and to practice the viva technique, which greatly improved my confidence. Overall, I felt that this form of learning and examination has been highly beneficial! 鈥撎�Student,听 Maya听Karnad BDS MJDF (Eng) (MSc Endodontics)

Staff feedback

Staff gave feedback and suggestions via online meeting after each mock viva session. Their suggestions have included a time gap between each candidate to account for any delay in signing into the session, to permit a听transition of examiners from one candidate to another.听

鈥�This project was a good example of how embracing digital education methods can make university teaching more versatile, inclusive and overcome challenges imposed by different timetables and limited availability of students and staff. The regular testing of the Blackboard Collaborate fulfilled a dual purpose: a) maintaining student engagement during this period, giving them the chance to apply their learnt knowledge to clinical scenarios and test their diagnostic and treatment planning skills; and b) allowing students and staff to become familiar with the online format and be ready to solve practical issues that may emerge. Personally, I enjoyed being part of this effort and explore the听potential of digital platforms like听Moodle.听 I think听the听format can be adopted well for other activities of our programmes such as the evening case-based discussions or for more personalised teaching for students that need further support. -听George听Milesis, Clinical Lecturer in Endodontology, Deputy Director of MSc/MClinDent听Programmes in Endodontics at 911爆料网 Eastman Dental Institute

鈥�Using Blackboard Collaborate was very positive experience overall.听 It was straight-forward to set-up and run, which facilitated multiple sessions to be held online. The practice sessions allowed streamlining of the process and for any IT issues to be resolved. In addition, this has permitted closer contact with the students and enabled further teaching to be completed as required.听I听听look forward to using it more in future, as I believe it will open up even more teaching opportunities. -听Elizabeth Hoy, Speciality Doctor in Endodontics

Looking ahead

Having fully tested this approach, we intend to听adopt听it听for听online teaching and assessment next year, to overcome any geographic barriers or lack of suitable physical venues.听

Image credit: Christina Wocintechchat / Unsplash