18/11/2016 08:10 GMT | Updated 18/11/2017 05:12 GMT

Why Universities Should Scrap Exams

How many teeth does a trainee dentist have to extract to qualify? Can you be sure a newly qualified dentist has ever taken out a wisdom tooth before being let loose on yours? Have you been put off going to the dentist for years because of a bad experience?

How dentists are trained, and for that matter doctors, nurses and other healthcare professionals is of interest to all of us. Whether it's mild toothache, moderate tinnitus, or a massive thrombosis, we want to be sure we are in the best possible hands.

So how are medical staff trained, and in particular, how are they assessed as ready to practise?

Well, they have to pass tests. Quite a lot of them. Tests range from short-answer questions, to essay-writing, to full-blown practical exams using mannequins, actors and real patients. And, by and large, medical students are good at doing tests. Look at the A level or high school grades they have to achieve to even get onto a university course. They know how to pass exams.


But does passing exams really mean that they are fit to practise? Much depends on what is in those exams and how the results are interpreted and followed up. I am not for one minute suggesting that medics' exams have no value or that our doctors, dentists and nurses are not first-rate. But what if there were a better way to develop their skills and assess their competency than for ever sitting exams?

Since joining an education tech start-up, I've discovered that there are new ways to develop, monitor and assess medical students. For example, it's now possible for tutors to stand next to a student in a clinic or ward, watch them drill a tooth, take blood or discuss a sensitive matter, and assess them right there, on the spot, recording observations and also jotting down suggestions for improvement, all on an iPad. That can happen day in, day out for three, four or five years, so that by the end of the course, you really do have a complete picture of how that student is doing across a whole range of skills with all types of patients. Yes, you can do this sort of thing on paper, but it's much easier to analyse the results if they are fed into an electronic database. You have literally thousands of observations - it's big data really.

The same approach can be applied to other types of courses besides healthcare. Getting constructive feedback, little and often, and having a record of that, is a fantastic way to help anyone learning something to make progress. It's particularly useful for subjects where there is work-based learning and lots of skills to learn. Monitoring a student's soft skills like teamwork, communication and display of empathy is also easier with a long-term, real-time approach in a way that exams just don't cut it. Employers frequently protest that graduates don't have the skills they need, and that could in part be down to the way students are assessed.

I saw a great cartoon at a conference recently. It showed scribbly pictures of students, mouths wide open, shouting, "Who are we?" "Students"; "What do we do?" "Tests"; "Then what do we do?" "We forget what we learned". Everyone who has been to school, let alone university, will recognize that sequence of events.

Just thinking about students' health for a moment, especially student mental health, there is evidence even among school pupils that exams are a major source of anxiety which can lead to ill-health. This is another important reason for re-examining the role of exams.

Going back to our original questions, the average number of teeth a trainee dentist at a UK dental school will take out is typically 50. There are anecdotes that it has been possible in the past for a dental student to avoid tackling the more difficult tooth extractions, but with the kind of regular close monitoring and logging I am describing, this risk is all but eliminated. One in four people fear going to the dentist and delay or avoid visits. Medical, dental and healthcare courses do increasingly address soft skills and the new training and monitoring methods I've described should help public confidence to grow.

Exams have their place and the processes involved in reading through notes, answering practice questions and performing under pressure undoubtedly can help learning. Some subjects and courses might be more suited to exams than others and exams can certainly help with setting standards. But the idea of more regular monitoring of students in different situations and of capturing that information for students and tutors to judge progress has to be a step forward. Universities should certainly consider scrapping exams.

Photo by David Bill