It’s time we had a discussion about the interuniversity progress assessment for medical students, abbreviated in Dutch as ‘iVTG’. If you’re unfamiliar with the iVTG, it is one of the more common ways in which medical students in the Netherlands are examined on their knowledge. The exam features questions on all major medical disciplines, ranging from psychiatry to dermatology, and must be taken by students at all stages of the degree programme. In this way, the standardised scores (rather than the subject matter of the exam) differ from one cohort to the next. As a result, students only have to sit one exam each quarter, and they are encouraged to keep learning throughout the year, rather than only studying right before exams.
Recently, the iVTG has been introduced in the Master’s degree in medicine taught at Erasmus University, after there had been complaints (taken all the way to the court of appeal) about the inspection procedure with regard to the end-of-block exams which had been administered until then. Or rather, there had been complaints about the lack of such an inspection procedure. Since the faculty had to administer more than 165 exams annually (yes, I did the maths) for its Master’s students, it was impossible from a practical point of view to grant students the right to inspect their exam papers. However, since the court ruled that students should be allowed to inspect their exam papers, the end-of-block exams had to be abolished. The alternative the faculty came up with was the iVTG.
The iVTG is a horrible exam. Four times per year, we must answer two hundred questions over the course of four hours. Two hundred questions! It’s such an insane number that we lose all focus after about one hundred answers and feel quite demoralised when we realise that we have another one hundred questions to go. In actual practice, this means that, after a while, we start answering questions based on associations rather than on a proper consideration of the matter at hand. Perhaps the iVTG really does assess our biomedical core knowledge this way, but to me, it feels more like an exercise in sadism.
The Erasmus MC has justified the introduction of the iVTG by being very critical of the former end-of-block exams. End-of-block exams, the faculty says, result in short-term learning, only give an impression of students’ knowledge at one particular moment in time and do not do a great job of measuring the way in which students’ knowledge is developing. While this is a fallacy, I can somewhat relate to it. However, it ignores the fact that end-of-block exams are firmly in line with an educational principle that we are being force-fed in the new Master’s degree, which is ‘just-in-time learning’, whereby we study knowledge previously gained during our Bachelor’s degree and deepen it with a view to the foundation programme we are supposed to follow in the hospital. If my understanding and experience are anything to go by, this principle is right, because it invites us to use information cleverly, rather than simply learning things by rote. The iVTG does not follow this examination principle, and therefore does not seem a logical fit with the kind of degree we are being taught.
From a bitter point of view, the introduction of the iVTG could be considered a contrived answer to the court’s ruling, as devised by policymakers. But I don’t really wish to be bitter. From a more reasonable point of view, I can see that the end-of-block exams were not sustainable, and that, at the very least, the iVTG is a breath of fresh air. Because in addition to the fact that compiling all these exams must have been tremendously time-consuming for lecturers, they also piled enormous pressure on students, who spent about nine hours a day at the hospital during their foundation programme, and then had to spend their evenings studying. Thanks to the new iVTG, we no longer have to do that. And honestly, I do understand that it takes two hundred questions to even come close to testing a student’s knowledge of the entire medical curriculum. However, that does not mean that this type of assessment is justified.
So what are we to do about these exams? Maybe we can get a hybrid type of exam, where specific questions are asked about whatever block the students have just completed, while also assessing students’ core knowledge? Or maybe we can introduce a much shorter version of the iVTG, which does not assess students’ knowledge of all aspects of medicine, but rather focuses on themes that have already been taught during the students’ foundation programme? I don’t really care, as long as there is some sort of idea behind it, some way to spar with students, and as long as it is relevant to the situation on the floor in Rotterdam, rather than merely copying a type of examination used by other faculties. However, in its current form, the iVTG is a huge blob of an exam, as well as a lazy solution. Therefore, I propose that we get rid of it.