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Assessment versus grading in the new european higher education area (EHEA), an ethical-critical approach

José Granero Molina,¹ Cayetano Fernández Sola,¹ Gabriel Aguilera Manrique^1
1Lecturer at the University School of Health Sciences, Nursing and Physiotherapy department, University of Almería. Almería, Spain

Mail delivery: José Granero Molina. C/ Lussex 9, 04120 Costacabana (Almería), España

Manuscript received by 18.6.2009
Manuscript accepted by 11.8.2009

Index de Enfermería [Index Enferm] 2010; 19(1): 37-41

How to cite this document

Abstract

The European Convergence process is a major change affecting most of European states, by introducing new elements in order to harmonize its policies. In terms of education, there are significant changes in educational systems, especially those concerning university studies. In this frame, new educational methodologies in nursing studies have started to develop through pilot experiences in different European universities. In this article, one of these particular experiences, developed by the University of Almería (Spain) is described, especially in terms of objectivity and considering exams as an exclusive assessment methodology. After an exhaustive review of this topic, and due to the unspecificity of reliable tools for assessing knowledge, as well as attitudes and skills, we propose an ethical-critical review of the assessment concept, from a practical rationality that goes far beyond positivist and utilitarian aspects.
Key-words: Teaching-learning/ Assessment/ Ethical dilemma/ European Union directives.

Introduction

    This particular situation of higher education in Europe has been a major challenge ever since the Bologna declaration (Bologna-Berlin 2003) became a milestone for universities and the knowledge society (EUA, 2003). The creation of the European Higher Education Area, together with the European Credits Transfer System (ECTS) aim to promote convergence of European higher education studies, before 2010, in a degree system of 3-4 years (240 ECTS) with the possible addition of a 1-2 year master (60-120 ECTS) or a doctorate programme. The last meeting of Education Ministries in London confirmed the structural and legislative changes that follow USA and UK models. Although a final phase has been reached, there are still many problems to sort out. The strategy is based on the education of students in any of the universities in this area, the Diploma Supplement, the creation of more competitive degrees, the involvement of companies, language teaching and lifelong learning; a change from arts to technologies, including health sciences (Iza & García 2003).
    The roles of lecturers and students, as well as the teaching-learning methodology and knowledge assessment have been modified (Turner et al 2003), which was already promoted in the United Kingdom during the 90s. Not only did it change the lecturer's tasks (Gillespie & McFetridge 2006), but also his practical competences, the promotion of creativity, freedom of thought, and originality in assessment (Girot 2000). The adaptation of European nursing to these changes, as well as other degrees, depends on the particularities of each country (Aghatangelou 2004). As a consequence, the European Association of Universities fears that superficial changes are implemented instead of following the full objectives of competitiveness, knowledge transfer or patent generation. Another risk may be based on the fact that university can fall into a business model, which would question the fundamental values of higher education in Europe.
    The main focus of teaching is oriented towards the student's learning (Haynes 2004). Students should acquire new competences related to leadership, self-learning, decision-making and ethical commitment. Lecturers must renew their pedagogy: less contents, teaching small groups, cooperative work and review of teaching and assessment methodologies. Time management will also change, since ECTS credits include student work, as opposed to traditional educational practices that used to link face-to-face hours and exams with a guarantee of success in competence learning (Mallaber & Turner 2006).
    In this manner, new approaches are arising about the ethics-education relationship in the integral learning of nursing. There are critical evaluations of the educational scientific model as opposed to the real life as a practical learning base (Birkelund 2000) as well as an ethics of praxis based on virtues (Armstrong 2006).
    Training for this job in Europe has now a new dimension. However, faced with the implementation of this process, European universities are developing experimental projects in order to analyse learning and assessment, as it previously happened in other countries, such as the USA (Bartels 2005). In the Health Sciences University School of the University of Almería, Spain, a pilot experience was carried out during 2004-2005 for nursing studies, and it is generating many new approaches on the process.
    We undertook an exploratory study and an analysis through a systematic bibliographic review on scientific and research literature, using the following databases: MEDLINE, CINHAL, BIREME and CUIDEN. We especially looked for evidences about the efficiency of a written exam as a useful method of proving students' knowledge and its differences with regard to the new concept of ethical-practical assessment introduced by the EHEA.

Assessment in nursing studies. Technical rationality versus practical rationality

    As in the case of diagnostic practice, where systematic models are losing their connection with real clinical situations (Lee et al. 2006), documentation on students' assessment is still almost non-existent. The differences between external evidence and individual clinical experience overshadow the decision-making process in practice. If there is no evidence for assessment, decisions must be taken according to particular contexts and individual experiences (Avis & Freshwater 2006). So far studies on nursing assessment fall into the category of descriptive summaries rather than systematic reviews, experimental works or evidence synthesis (Johnson 2004). The need of controlling hidden variables is crucial, but in educational contexts their experimental control is not always ethical or feasible. Although certain models, such as the objective structured clinical exam (OSCE), have been adopted by Physiotherapy and Nursing studies, there are problems related to their reliability and the fragmentation of the holistic nature of health care (Rushforth 2006). When it comes to assess a student, how to grade intuition? Intuition is opposed to rationalism and it is rejected as a scientific knowledge source, but it is recognized by decision-making literature (Rashotte & Carnevale 2004).
    Concerning technical-scientific issues, certain problems arise from the technical rationality perspective, which is based on evidence. Controlled trials are regarded as the most solid basis for interventions (Thomsom, 2004). The objectivity of the process is questioned and the existence of care scientists appears to be a major need in order to stimulate innovation and enhance knowledge transfer (Titler, 2004). In the assessment field, neutrality and grading seem to be main concerns. Teaching and learning processes do not go in the same direction.
    Practical rationality emphasizes commitment face to evaluative neutrality. It goes beyond finalist or utilitarian rationality, and it is based on educational theories and the suitability of assessment methods as a quality indicator process (Edwards 2001). The ethical-practical component predominates in learning assessment: how we behave assuming personal commitments, the use of results by the lecturer or the student outside the class, a critical attitude face to a dogmatic education, diverging thinking face to the fear to mistake and imposed contents. It does not reject theory as a way of understanding and explaining real world phenomena, but it incorporates its meaning (Dahlberg & Dahlberg 2004). That is why, as far as assessment is concerned, all contradictions emerging from social and educational systems overlap.
    Nurses need a theoretical background, but also an interpretive knowledge of the clinical situation (De Raeve & Wainwright 2001), because gaining access to life-world cannot be done through the remnants of positivism and leaving the value of meanings aside (Dahlberg & Dahlberg 2004). It should rather be perceived from a dialogue on the effects of human progress beyond dominant theories (Clinton, 2005). On the basis of tolerance and respect to a basic human dignity (Yeuk 2005), nurses see and listen to the patient, they understand his suffering and record observations carefully (Määttä 2006). Following this integration from the beginning of education, students would be immersed in a bicultural approach, enabling them to solve collaborative problems while responding to patient needs (Purkis 2006).
    Shall we learn together? This would ensure a good assessment procedure. However, this practice is nowadays rejected, since evaluative, affective and moral neutrality does not find a place in a learning scenario where people are interacting. This is why assessment involves a way of seeing the world, the person, the job and life. The step from grading to assessment affects all people involved in the process. There are reflexive learning experiences that include the professional lecturer's assessment, interpersonal relationships, teaching methods and the provision of learning outcomes (Ling et al 2002). But also the student experience about effort, time, memorization, values, the social role and relevance of the information to be learnt and assessed (Magnussen & Amundson 2003). During formative assessment, lecturers learn how to improve their teaching practice, how to reorient educational strategies and not to hide weakness before pretended objectivity criteria; students learn from questions as a challenge; from a well-informed correction, and from reasoned criticism (Alvarez 2006). If we ignore this, even if we grade objectively, assessment will not be fair.

Examination as a tool, assessment as a practice

    Examination is not a definite tool to significantly determine teaching and learning quality.
    -It describes punctual situations rather than an updated, reflexive and global understanding of knowledge. Students may learn theory, write good papers and pass exams, but they will not become high-quality professionals with practical knowledge (Beegley 2006).
    -It is easy to give a numerical grading, but it does not inform about what students or lecturers have learnt or the nature of their interrelationship. It restricts the lecturer's function to confirm ignorance and to approve a type of exclusion that does not educate or teach, but it rather punishes.
    -It expresses what the student knows from what the lecturer has explicitly taught. It is not very analytical and by no means creative. It avoids content analysis, values and creativity. It simplifies the performance and richness of knowledge, since it deals with reality from a static notion, far from flexible solutions (Adamczyk 2006) and it misdeals with diversity and pluralism. Critical learning is a basic aim in nursing studies (Di vito 2000).
    -It promotes hegemonic cultures since it restricts human contexts to simple categorization far beyond cultural values, as opposed to learning experiences and cultural competences achievement experienced by Erasmus students (Wimpenny 2005).
    -It creates false expectations of justice and equity, promoting an illusory egalitarianism and a symbolic power that does not find any support from studies describing the lack of correlation between the exam mark and the clinical experience of the student (McManus et al. 1998).
    -Examination cannot determine the teaching-learning process among human beings. The problem of written examinations was already raised in other places, such as in Scotland. Exams do not foster a creative thinking and they are not linked with job values (Altschul & Sinclair 1989). We must balance assessment procedures with aims and learning methods (Edwards et al 2001), raise questions aimed at challenging students' thinking, conceptual integration and reasoned argumentation. But let's not expect brilliant answers to trivial questions or honest answers to tricky questions. It is thus important to:
    -Negociate criteria with the student (James 1990), writing down an objectives agreement.
    -Choose correctly the tools to be used according to purposes and knowledge complexity. It affects students' motivation for learning the subject. This is an already studied issue in certain areas, such as Physiotherapy and Educational Therapy (Seale et al. 2000).
    -Make explicit what is essential and what is secondary. Most of the time, only relevant issues for practice or clinical research should be taught (Adamczyk, 2006).
    -Stimulate learning and critical attitudes, by introducing reflexive methods questioning reality and analysing concepts, discussions and demands. This would enhance self-confidence and credibility (Holt & Clark 2000).
    -Explain the use of obtained results in their context. It makes grading more valuable. Experiences combining examination and self-assessment stimulate discussion, which allows for an individual reflection on capacities, aims and priorities (Mattheos et al. 2004).

    The success of knowledge assessment will depend on applying imaginative models, such as the development of the Clinical Nurse Leader (CNL) role. These models enhance contextualized capacities and practical skills from curriculum plans and different programs such as the Doctorate of Nursing Practice (DNP) (Bartels 2005). First of all, practical knowledge must be validated and defined. Then, assessment methods should be determined. Several nursing studies focus on the assessment of educational strategies to ensure that students really acquire management competences in certain issues, such as pain (Twycross 2002). However, knowledge cannot only be expressed in a text or through nursing education. Knowledge and skills are also acquired through concrete personal situations, which require a physical proximity to the studied phenomenon (Wellard et al 2007). More important than tools is the use we make of them. Certain studies on the efficient perception of clinical educators by students do not regard assessment as an essential factor (Lee et al. 2002).

An ethical-critique vision of the evaluation concept

    Nursing care practice includes reasoning, behaviour and social interaction (Lee et al. 2006). In ethical terms, it is a personal and social process mediated by the educational methods used at university (Doane et al. 2004). The dominant utilitarianism neglects wisdom or clinical judgement and influences teaching, learning and assessment processes. Lecturers promote student's learning and give recommendations for a nursing ethics that fosters the decision-making process (Gastmans 2002). Nevertheless, there are certain aspects that cannot be taught without clinical practice (Määttä 2006). As a result, assessing them without considering context does not make much sense. The integration of knowledge, attitudes and skills requires a methodology to assess practical issues. Although there is little scientific evidence, it is necessary to apply the same rigour as for theoretical aspects (Turner et al. 2003).
    In a multicultural society, a pluralist and interdisciplinary education (Glen 1999) must also deal with other questions, such as the role of nurses in human rights protection, which are not taught or assessed as they deserve (Chamberlain 2001). Even if there are studies which have found a positive correlation between first and next year marks (McCarey et al. 2007), they do not regard them as a predictive factor, since in the clinical practice domain, exams cannot determine acquired knowledge and skills, they rather underestimate clinical practice as a learning source (MacManus et al 1998). Assessment methods will thus need to be modified and learning opportunities in different environments, as well as the integration of practical and theoretical knowledge should be reinforced (Edwards et al. 2001). Methodological challenges are complex whereas solutions seem to be implausible; this is why research design should account for context (Attree 2006). Innovative strategies are needed in nursing studies in order to promote assessable competences beyond the traditional written exam, which is a relevant issue for health care practice (McGrath & Higgins).
    Narrative pedagogy adds critical and phenomenological elements enhancing learning experiences, stimulating empathic care and a participating personalized understanding (Davidson 2004). Reflexive diaries allow to determine the efficiency of a nursing practice-based theory, which is not contemplated in current clinical situations (Corlett 2000). Conceptual maps are useful to strengthen and evaluate critical thinking, and even if there is little evidence of them being used in practice, they are starting to be considered for problem solving, decision-making and action plans development (Gul and Boman 2006). In the assessment of cultural capacities we can make use of Erasmus or international exchanges experiences, since they enhance the capacity to work in multicultural health care teams. They also promote personal growth and the improvement of communication. All these factors should be considered in the design of new curricula. (Koskinen & Jokinen 2007). It is necessary to find the role of technology in the acquisition process of nursing competences, because simulated learning reduces the necessary hours of clinical practices for basic skills acquisition. It does not replace all of them, but it is useful for assessment (Gasset 2006). The online education boom is a great chance to integrate critical thinking and problem-solving strategies in nursing (Posey & Pintz 2006), although the practical nature of this discipline makes this procedure debatable when assessing certain competences.
    The cooperation of all people involved in the educational process is essential (Baxter 2007). Surveying nursing users' expectations would contribute to define concrete elements to assess. Assessment requirements should be based on knowledge and technical skills, but also on personal qualities resulting in a more efficient health care (Calman 2006). Patients ask for students to be assessed according to their understanding of the disease, its impact on people's life and health care professional attitudes towards them (Towle 2006). If the EHEA convergence process is focused on the student, students should be stimulated to participate in the design of curricula, methodologies and assessment processes, since their perspective is different from those of university members.
    The key question is: is it possible to develop a system to determine nursing students' knowledge and complex skills without falling into the fantasy of the perfect exam? (Wellar et al 2007). Students themselves make the relationship between a discipline's valid and legitimate knowledge and what is required in an exam, but certain research works show the uselessness and the lack of correlation among this kind of approaches (McManus 1998). There is a current need for research in this field, but it is also necessary to come up with solutions within the historical process of the EHEA creation. Nursing education needs to get rid of quality constraints (Clarke 2003), since its individual and contextualized application is questioned among university members. Facing learning, teaching and assessment, methodology is part of an opened dialogue between students' life-world and the current situation. The challenge lies in defining a method, but without being subordinated to the determinist nature of its structure (Ekeberg 2005).

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