title: Progress testing in the medical curriculum: students' approaches to learning and perceived stress.
abstract: BACKGROUND
  Progress Tests (PTs) draw on a common question bank to assess all students in a programme against graduate outcomes. Theoretically PTs drive deep approaches to learning and reduce assessment-related stress. In 2013, PTs were introduced to two year groups of medical students (Years 2 and 4), whereas students in Years 3 and 5 were taking traditional high-stakes assessments. Staged introduction of PTs into our medical curriculum provided a time-limited opportunity for a comparative study. The main purpose of the current study was to compare the impact of PTs on undergraduate medical students' approaches to learning and perceived stress with that of traditional high-stakes assessments. We also aimed to investigate the associations between approaches to learning, stress and PT scores.
  
  
  METHODS
  Undergraduate medical students (N = 333 and N = 298 at Time 1 and Time 2 respectively) answered the Revised Study Process Questionnaire (R-SPQ-2F) and the Perceived Stress Scale (PSS) at two time points to evaluate change over time. The R-SPQ-2F generated a surface approach and a deep approach score; the PSS generated an overall perceived stress score.
  
  
  RESULTS
  We found no significant differences between the two groups in approaches to learning at either time point, and no significant changes in approaches to learning over time in either cohort. Levels of stress increased significantly at the end of the year (Time 2) for students in the traditional assessment cohort, but not in the PT cohort. In the PT cohort, surface approach to learning, but not stress, was a significant negative predictor of students' PT scores.
  
  
  CONCLUSIONS
  While confirming an association between surface approaches to learning and lower PT scores, we failed to demonstrate an effect of PTs on approaches to learning. However, a reduction in assessment-associated stress is an important finding.
authors.affiliation: Centre for Medical and Health Sciences Education, University of Auckland, Building 599, Level 12, Auckland City Hospital, Private Bag 92019, Auckland, 1142, New Zealand. ya.chen@auckland.ac.nz.
authors.forename: Yan
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Centre for Medical and Health Sciences Education, University of Auckland, Building 599, Level 12, Auckland City Hospital, Private Bag 92019, Auckland, 1142, New Zealand. m.henning@auckland.ac.nz.
authors.forename: Marcus
authors.initials: M
authors.lastname: Henning
authors.affiliation: Medical Programme Directorate, University of Auckland, Auckland, New Zealand. j.yielder@auckland.ac.nz.
authors.forename: Jill
authors.initials: J
authors.lastname: Yielder
authors.affiliation: Te Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand. rg.jones@auckland.ac.nz.
authors.forename: Rhys
authors.initials: R
authors.lastname: Jones
authors.affiliation: Clinical Skills Centre, University of Auckland, Auckland, New Zealand. a.wearn@auckland.ac.nz.
authors.forename: Andy
authors.initials: A
authors.lastname: Wearn
authors.affiliation: Centre for Medical and Health Sciences Education, University of Auckland, Building 599, Level 12, Auckland City Hospital, Private Bag 92019, Auckland, 1142, New Zealand. j.weller@auckland.ac.nz.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Weller
mesh_terms: D003479:Curriculum / Q000706:statistics & numerical data; D004504:Education, Medical, Undergraduate / Q000379:methods / Q000706:statistics & numerical data; D004521:Educational Measurement / Q000379:methods / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D006801:Humans; D007858:Learning; D008297:Male; D013315:Stress, Psychological / Q000453:epidemiology* / Q000209:etiology; D013337:Students, Medical / Q000523:psychology* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires