You Get What You Reward: A Qualitative Study Exploring Medical Student Engagement in 2 Different Assessment Systems

Area of Science:

• Medical Education
• Assessment Design
• Student Engagement Theory

Background:

• Student engagement is crucial for educational impact.
• Assessment design influences student focus and effort.
• Limited understanding exists on how medical students engage with assessments.

Purpose of the Study:

• To investigate how medical students engage with assessment processes and data.
• To compare engagement in traditional tiered grading versus programmatic assessment systems.

Main Methods:

• Multi-institutional, cross-sectional constructivist grounded theory study.
• Involved fourth-year medical students at two institutions.
• Utilized semistructured interviews guided by engagement theory, followed by qualitative analysis.

Main Results:

• Three domains of engagement identified: affective, cognitive, and behavioral.
• Engagement influenced by assessment as a sociocultural statement of value.
• Cognitive load and locus of power/control emerged as key factors.

Conclusions:

• Student beliefs about assessment goals, cognitive burden, and relationships impact engagement.
• Traditional grading systems may encourage prioritizing image over learning.
• Programmatic assessment systems promote more authentic engagement for learning.