I recently heard two students in academic difficulty recount painfully similar stories about how their own studies had come off the rails following the attempted suicide of younger siblings, who were themselves college undergraduates. What are the chances of hearing two such stories in one day? Well, according to Emory University’s statistics, there are 1000 suicides per year among college students and as many as 1 in 10 students have made a plan for suicide at some point¹.

I do not pretend to understand such shocking statistics. Known stressors for college students include interpersonal factors such as new social environments and relationships, personal factors like poor sleeping and eating habits and financial problems, academic workload and poor grades². There are many things here I cannot help with directly, but on the academic side it does make me reflect on what can I do as a professor to help?

I am a physiologist, not a counselor or a psychiatrist. However, I can begin by learning what counselling services my university has (they are excellent as it turns out – and I bet yours are too), and I can do a better job of guiding distressed students to seek their help; if the need arises I can ask students straight out if they have suicidal thoughts and I can dial 911 if necessary. But another thought occurs to me….at certain points I become the focal point for student stress and that happens each time I choose to set a high stakes exam.

It is an old axiom that assessment drives student learning but with such power comes great responsibility! The stress incurred by students through testing (especially when graded) must come with some tangible educational benefit. In other words, I must weigh the costs and benefits of deciding to set up a particular assessment and especially how much summative testing to include in the block. After all, we know that the rate of forgetting is significant, even after the mega high stakes United States Medical Licensing Exams³.

One strange observation I have made over time is that students and faculty often align with wanting more testing; students want to lessen the burden of information per test and faculty want more complete sampling of the material. I have struggled in three different institutions to reduce summative testing load and to replace some tests with formative testing instead. Each time, student score distributions at the end of a course were not affected, whereas student stress levels seemed lower and the classroom was a more relaxed and enjoyable place.

Is all testing bad or can assessment be a win-win where positive educational impacts outweigh the negatives? Progressive testing methods such as project-based assessment and collaborative assessment align with 21^st century goals of graduating students with competencies in critical thinking, communication skills, technology literacy etc., perhaps without the same level of stress that cramming for knowledge-based tests produces. Recent studies have convincingly shown that frequent zero-stakes testing used as a means to rehearse content produces major learning gains in what has been coined the “testing effect⁴”. Commercially available adaptive learning platforms are also available in which the technology helps students to continually self-assess towards achievement of mastery⁵.

As a faculty member I can help to address student burnout and stress by carefully considering my choices of summative assessment and maximizing testing for learning. I believe we need to be intentional about teaching students how to learn by addressing learning preferences, motivation and self-regulated learning habits. The dismaying statistics I started with suggest universities should also provide more learning opportunities on wellness, nutrition, resiliency, lifestyle management, financial planning, etc., as part of all our programs. I realize there are many other factors to think about and hope some discussion will follow to explore these gaps.

Resources

1. Emory Cares 4 U. Suicide Statistics http://www.emorycaresforyou.emory.edu/resources/suicidestatistics.html Accessed 4/22/16
2. Ross SE, Niebling BC, Heckert TM. Sources of stress among college students. College Student Journal 33 p312-318, 1999
3. Ling Y, Swanson DB, Holtzman K, Deniz Bucak S. Retention of basic science information by senior medical students Academic Medicine 83(10 Suppl):S82–S85, 2008
4. Karpicke JD, Roediger HL 3rd. The critical importance of retrieval for learning. Science 319:966–968, 2008
5. Flashcards. Memory Aids. An automatic study plan for every lecture. https://www.osmosis.org/ Accessed 4/22/16

J.D. (Jon) Kibble graduated from the University of Manchester in 1994 with his BSc and PhD in physiology. In his first faculty position at the University of Sheffield Medical School, Dr. Kibble started a research laboratory to investigate the molecular physiology of renal tubular ion transport. His passion for teaching was ignited at this time as he began to teach medical physiology and anatomy. Next he became a Course Director for Medical Physiology at St. George’s University in the West Indies and later at The Memorial University of Newfoundland in Canada. The experience of teaching over 4,000 medical students in different parts of the world established his academic base as a medical physiology teacher.
Jon moved to the United States in 2008 to join the founding faculty of the University of Central Florida, College of Medicine. In 2010 he was appointed as Assistant Dean for Medical Education and is responsible for overseeing the development of basic science content throughout the curriculum. His scholarly work includes publication of learning resources in the form of a textbook on medical physiology, flashcards and electronic resources for adaptive learning. His primary research interest relates to the efficacy of formative assessment and understanding student engagement in self-assessment.
Jon became a Fellow of UK Higher Education Academy in 2007, is deputy editor of the journal Advances in Physiology Education, currently chairs the American Physiological Society’s Teaching Section and is a member of the International Union of Physiological Society’s Education Committee. He was the recipient of the Alpha Omega Alpha Robert J Glaser Distinguished Educator Award, 2015.