Medical schools have been reviewing their curricula to prepare caring and competent health professionals in the midst of a knowledge and technology explosion. The implementation of problem-based learning curricula signalled attempts to make learning more significant, based on constructivist perspectives that emphasise social interaction for meaning making and understanding. Available literature suggests that learning in PBL should be assessed by authentic, contextual real-life tasks that support and encourage students’ learning. To this end, the Nelson R. Mandela School of Medicine implemented the progress examination (PE) to complement the aims of Curriculum 2001 (C2001). The potential formative function of the PE was specifically appealing in terms of allowing for the development of reflective, self-directed and deep learning. Early explorations revealed an apparent mismatch between the aims of C2001, the expectations of stakeholders and their experiences with the PE at the site and these resulted in a number of adaptations to the examination. Cognisant of the influence of assessment on students’ learning, this study sought to examine whether the educational principles governing the implementation of C2001 also informed the implementation and adaptations of the PE. Using a qualitative case study methodology, the study investigated stakeholders’ understandings of the PE and its goals and the lived experiences of its implementation as a suitable tool to assess students’ cognitive learning. In addition, the study also investigated the possible factors that influenced the reform. Findings suggest that the PE was not suitable to assess students’ learning in C2001. Despite the perceptions of a strong educational need for curriculum reform and the apparent suitability of the PE, some members of staff lacked understanding, skill and confidence to apply and implement its aims. Staff failed to apply transformative practices of teaching and learning, while the principles of the PE and C2001 were not well diffused through the organisation. Members of staff expected the PE to differentiate between high and low performing students, while students came to regard the examination as just another hurdle in an already hostile learning environment. Factors such as the unstable and poor leadership, the restructuring of the health and education sectors, impacted on the implementation of the reform. Curriculum and assessment reform is challenging for students and lecturers, requiring the transforming institution to actively prepare and support stakeholders in a conducive educational climate. This case study highlights the need for comprehensive planning for effective and sustained curriculum reform. Collaborative strategies and educational systems should be sought and implemented to sustain conceptual and practical reform.

Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2009.