title: Use of certainty-based marking in a second-year medical student cohort: a pilot study.
abstract: BACKGROUND
  Assessments which consider both competence and confidence attempt to provide insight into actual performance in order to optimize physician capabilities, providing motivation and direction for future learning. The aim of this project was to assess medical students' thoughts and opinions of the utility of a certainty-based marking (CBM) protocol with respect to improving their learning experiences.
  
  
  METHODS
  Second-year medical students at the University of Queensland were provided with a series of optional online formative assessment tools, in the form of 10 sample questions, to support their current module learning outcomes. During four consecutive weeks, CBM was offered on weeks 1, 2, and 4, with week 3 being provided in the usual question-answer format. A mixed-method survey was distributed at the conclusion of the trial period to obtain feedback on the students' impressions of learning via this technique.
  
  
  RESULTS
  Of the 400 students, 15%, 11%, 9%, and 8% used the resource over the four-week period, respectively. During the four-week module directly prior to the test module, 46%, 44%, 44%, and 40% of the students accessed the sample questions which were delivered in the usual multiple choice format. A majority of the students either agreed or strongly agreed that CBM was easy to understand (52%) and useful (57%), but took more time (67%) because they needed to consider their certainty level for every question (76%). A number of students (43%) also stated that CBM affected their attitudes toward decision-making, while 86% thought it would be most useful for revision as opposed to an examination format.
  
  
  CONCLUSIONS
  Despite the inherent benefits of gaining experience in higher order thinking processes, students were less likely to participate in the CBM tasks than standard multiple choice, even though these did not count toward their final grades.
  
  
  CONCLUSIONS
  Utilizing such practices at the beginning of an educational program may minimize apparent resistance and alter learning practices to become conducive to deeper levels of learning. This has been corroborated in other studies aiming to encourage similar higher order cognitive processes.
authors.affiliation: Centre for Medical Education, Research and Scholarship, School of Medicine, The University of Queensland, Australia.
authors.forename: Niikee
authors.initials: N
authors.lastname: Schoendorfer
authors.forename: David
authors.initials: D
authors.lastname: Emmett
keywords: assessment; certainty-based marking; medical education