E-learning and Assessment

Version 4.
Reference http://wiscinfo.doit.wisc.edu/teachingacademy/Assistance/course/questions.htm
The education strategy (March 2004) has highlighted that Bristol University:1. Is a research intensive university where the student learning experience is
informed by research and is delivered by research active staff.
2. Wishes to retain its high quality teaching.
3. Needs to widen access and to look at diverse progression routes into HE.
4. Needs to expand postgraduate numbers particularly on taught masters
programmes
5. To retain their highly rated international research output and to deliver high quality
teaching, requires that teaching is cost effective.
Whilst E-learning has a relevance to all of these points, this paper will focus on point 5 i.e.
the requirement for teaching to be cost effective. The contribution of E-learning to
assessment is a major area where substantial gains in efficiency can be achieved.
Currently staff spend a significant amount of time
1. setting examinations
2. ensuring that they match course learning objectives,
3. liasing with the external examiner
4. marking
5. exam related student administration
Much of this activity is repeated at least twice per year and sadly the outcome is often only
summative rather than formative. Several staff within the university have already adopted
CAA (computer aided assessment) as a means of addressing this problem and have
found pedagogic as well as efficiency gains. However this approach has not yet become
embedded. Reasons for this limited uptake include:1.
2.
3.
4.
5.

Lack of staff time

Lack of priority by university managers
Lack of reward
Techno phobia
Lack of knowledge/understanding of how e-learning can help. Specifically many
staff still believe that CAA is only capable of simple multi choice questions which
test recognition.
6. A multitude of software packages which are evolving and for which support is
varied. Academic staff whose interest is primarily the pedagogy of their own
subject, find the technological developments both confusing and frustrating.
7. Academic staff perception that the technology is driving the pedagogy, rather than
the student learning experience being informed by research and delivered by
research active staff.
It is therefore essential that any development of CAA within the University of Bristol must
address these issues. Specifically the technology must:1

1. Match the needs of academic staff

2. Be relatively simple to use, be well supported and not evolve rapidly in the
short term. It is therefore important to get the specification right first time and
not be continually updating it. The current design should therefore match not
just current (short term) but also our future (medium term) needs.
3. Be capable of assessing at all levels of Blooms Taxonomy (see later)
4. Fit within our portal (MLE)
5. Support the latest technical interoperability standards to facilitate easy
transfer of content to another CAA application if required at a later date
6. Be secure, both meet Data Protection/privacy requirements and have robust
mechanisms in place to deal with machine or network failures
7. Be scalable - while any CAA might initially be implemented in one or two
areas it should have the potential to be used across the University
Before examining question and assessment types, it's beneficial to establish a common
language for discussing cognitive processes. To assess specific levels of student mastery
of course content, needs a framework for describing those levels. Bloom's taxonomy is a
system created to improve testing precision by categorising cognitive functioning into
distinct levels. Appropriate questions can then be developed to assess the desired level.
Psychologist Benjamin Bloom developed this system at the University of Chicago in the
late 1940s. His goal in formulating this classification was to increase precision in the
discussion of educational goals among teachers, administrators, and researchers.
Bloom's levels are:
1.
2.
3.
4.
5.
6.

Knowledge
Comprehension
Application
Analysis
Synthesis
Evaluation

1
2
3
4
5
6

"Taxonomy" is simply a system of categorizing and organizing. In this case, the taxonomy
is hierarchical; each level is subsumed by the higher levels. In other words, a student
functioning at the "application" level has also mastered the material at the "knowledge"
and "comprehension" levels.
Before taking a closer look at the levels, it should be noted that Bloom's taxonomy is not
the only system of classification for cognitive domains. However, it is a widely accepted
system, and is useful in illustrating how certain question types are better choices for
assessing different levels of student mastery. What's important is the idea that student
knowledge is not all equal; there are levels of mastery ranging from simple recitation of
facts, to formulating informed opinions regarding complex issues. An awareness of these
levels can help one determine how well do students really know course content.

Table 1 : Blooms Taxonomy of Learning

Level
Knowledge

Learner Action
Recall content in the exact form that it was presented.
Memorisation of definitions, formulas, or procedures are
examples of knowledge-level functioning

Question Cues
List, define, label, identify, name

Comprehension

Restate material in their own words, or can recognise

previously unseen examples of a concept.

Describe, associate, categorise,

summarise

Application

Apply rules to a problem, without being given the rule or

formula for solving the problem.

Apply, calculate, illustrate, solve

Analysis

Break complex concepts or situations down into their

component parts, and analyse how the parts are related to one
another.

Analyse, compare, separate, order, explain

Synthesis

Rearrange component parts to form a new whole.

Combine, modify, rearrange, "what-if"

Evaluation

Evaluate or make judgments on the worth of a concept, object,

etc. for a purpose

Assess, decide, grade, recommend,

explain, judge

Introduction to Exam Question Types

1. True/False
2. Matching
3. Multiple Choice
4. Short Answer
5. Calculation
6. Translation
7. Essay
8. Problem based
9. Comprehension - 'Gobbets'
10. "Simulation testing"
11. "Performance"
. That is, they do not require the students to construct an answer themselves. Rather, the
answer is among the possible options. Closed-ended questions test recognition; that is,
they evaluate a students ability to recognize the answer. However questions that are built
around a scenario, some data, a graph or a table of numbers can require students to deal
with the information in order to determine the correct response.
Open-ended questions include short answer and essay types. These questions require
the creation of a written response. Open-ended questions test student recall; the student
is asked to come up with the answer on their own, as opposed to picking it out from a list
of potential options.
"Problem based", "simulation testing" and "performance" all assess the student's ability to
undertake a process and therefore need to assess skills as well as knowledge. Traditional
written examination formats clearly are not an appropriate form of assessment. E-learning
provides an opportunity to develop assessment tools which are matched to these learning
objectives.
1. True/False Questions
a. Advantages:
True/false questions are among the easiest to write, and can be scored
electronically.
b. Disadvantages:
True/false questions are limited in what kinds of student mastery they can assess.,
as opposed to recall. However properly crafted True/False questions require
students to recall relevant knowledge, reason or make some deduction about the
mechanism and so arrive at their most likely correct response which hopefully is
one of the choices.
c. Most Appropriate For:
Factual information and naturally dichotomous information (information with only
two plausible possibilities). Dichotomous information is "either/or" in nature.
Examples include male/female, analog/digital, and internal/external.

2. Matching Questions
a. Advantages:
Matching items can assess a large amount of information in a confined space on
the exam page, relative to multiple-choice questions; if developed carefully, the
probability of guessing is low. To decrease that probability further, avoid equal-sized
lists by including a few distractor items in the second (answer) column.
b.
c.
Assessing student understanding of related information. Examples of related items
include Symptoms and diagnosis, intervention and risks, terms and definitions,
tools and uses, and events and dates.

TABLE 2 Question types

Question type Description
True/false
Present a statement, and prompt the student to choose
whether the statement is truthful
Matching
questions

Involve paired lists that require students to correctly

identify, or match, the relationship between the items

Multiplechoice

Ask students to choose from a list of possible answers.

Most multiple-choice questions feature one correct
answer, and two to four "distractor" choices that are not
correct.

Short-answer

Open-ended questions that require students to create an

answer. Short-answer items typically require responses of
one word to a few sentences. Fill in the blank and
completion questions are examples of short-answer
question types.
Present a statement which includes variables from a
formula that is being assessed. The particular instance has
variables replaced by specific numbers so the calculation
can be performed. Can also test understanding of
dimensions appropriate to the calculation. Can also
handle inexact responses - so making students aware of
the precision of answers.
Students are required to translate a passage from one
language to another specified language observing the
grammatical structure, idiomatic expression and literary
tone of the piece.
Like short-answer, are constructed-response questions.
However, essay answers are typically much longer than
those of short-answer, ranging from a few paragraphs to
several pages.

Calculation

Translation

Essay

Comprehensio
n
'Gobbets'

Students must respond to a passage or image, often

without the prompt of a specific question. They will have
to interpret (and sometimes identify) the passage/image
and should be able to relate it to its wider context. These
questions specifically test the student's ability to create
answers and to make sensible links between specific
items and wider academic debates.

Problem
based

Students are asked to interpret information and make an

informed decision as to what further information is
required so that judgements, decisions and course of
action can be decided upon.

Blooms levels
Knowledge
Comprehensio
n
Knowledge
Comprehensio
n
Knowledge
Comprehensio
n
Application
Analysis
Knowledge
Comprehensio
n
Application
Analysis
Knowledge
Comprehensio
n
Application
Analysis
Knowledge,
Comprehensio
n, Application,
Synthesis
Knowledge
Comprehensio
n Application
Analysis
Synthesis
Evaluation
Knowledge,
Comprehensio
n, Application,
Analysis,
Synthesis,
Evaluation
Knowledge
Comprehensio
n Application
Analysis
Synthesis
Evaluation
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"Simulation
testing"

Use of a simulation capable of testing (in a controlled

way) a student's ability to carry out a process.

"Performance"

Examination by performance raises particular difficulties

of assessment and documentation. Performance-based
assessments test the student's interpretation and
presentation of material and observation of the
conventions of genre (dramatic genre, scholarly
presentation etc). Students are also assessed on their
ability to work as a group and to communicate to an
audience.

Knowledge
Comprehensio
n Application
Analysis
Synthesis
Evaluation
Knowledge
Comprehensio
n Application
Analysis
Synthesis
Evaluation

3. Multiple Choice Questions

a. Advantages:
Multiple-choice questions are the most versatile of the closed-ended question
types. This versatility stems from the fact that the questions can contain more
elaborate scenarios that require careful consideration on the part of the student.
The probability of student guessing is also relatively low.
b. Disadvantages:
When compared to true/false and matching, multiple-choice items can be more
challenging to write. They also require the creation of plausible distractors, or
incorrect answer options. As with other closed-ended questions, multiple-choice
assesses recognition over recall.
c. Most Appropriate For:
Factual, conceptual, or procedural information. Unlike true/false and matching,
multiple-choice is not limited to a particular type of information for which it is best
suited.
Because of the versatility of multiple-choice questions, the examples in this section
will focus on demonstrating how an effective multiple-choice question can test for
each of the first four levels of Blooms Taxonomy.
Knowledge Level
The value that occurs most frequently in a given data set is the:
a. Mean
b. Standard deviation
c. Mode
d. Median
The answer is c. This is a knowledge-level question because it requires
only that the student remember the definition of mode.
Comprehension Level
Which of the following measures involves ordinal data?
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a.
b.
c.
d.

The score of a football game

Football players jersey number
A teams rank in league standings
Number of fans in attendance

The answer is c. This is an example of a comprehension-level question, in

that it requires the student to recognize a previously unseen example of
ordinal data.
Application Level
The standard deviation of the sample data 6, 9, 10, 12, 13 is closest to:
a.
b.
c.
d.

3
5
8
10

The answer is a. This question assesses application-level mastery, or the

ability to apply a rule or formula in a new context.
Analysis Level
Susan, a student in Mr. Smiths statistics class, asks Mr. Smith what her
average score is for the three exams he has given the class. He replies that
her average is +1.7. Which of the following assumptions about the students
scores on these tests is most plausible?
a.
b.
c.
d.

The standard deviations of scores on all three tests were similar.

None of the tests produced extremely skewed distributions.
All of the students did poorly on at least one of the tests.
The correlations between the three sets of test scores were low.

Answer is d. This item requires the test-taker to recognize unstated

assumptions and relationships. The test-taker has to recognize the steps Mr.
Smith has taken (converted scores into Z-scores) and why he would do so
(the tests probably have very unlike distributions or lack of variation in one or
more tests).

4. Short-Answer Questions
a. Advantages:
Short-answer questions assess unassisted recall of information, rather than
recognition. Compared to essay questions, they are relatively easy to write.
b. Disadvantages:
Short-answer items are only suitable for questions that can be answered
with short responses. Additionally, because students are free to answer any
way they choose, short-answer questions can lead to difficulties in scoring if
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the question is not worded carefully. Its important when writing short-answer
questions that the desired student response is clear.
c. Most Appropriate For:
assessing the correct spelling of items, or in cases when it is desirable to
ensure that the students have committed the information to memory
(medical students, for example, will require recall of information more than
recognition by the nature of their jobs).
4. Calculation Questions
a. Advantages:
For simple formula this is a very easy and obvious question type. It can
generate a large set of potential questions automatically so each test can be
different. Handling dimensions and marking that aspect separately is another
useful feature. Method also allows for inexact responses so making student
aware of imprecision.
b. Disadvantages:
For more complex formula the capabilities might be too limited. Only suitable
for formula based questions.
c. Most Appropriate For:
Scientific material based on formulae that have a single solution.
5. Essay Questions
a. Advantages:
Essay questions can effectively assess all six levels of Blooms Taxonomy.
They allow students to express their thoughts and opinions in writing,
granting a clearer picture of the level of student understanding. Finally, as
open-ended questions, they assess recall over recognition.
b. Disadvantages:
There are two main disadvantages to essay questions: time requirements
and grading consistency. Essays are time-consuming for students to
complete, and require careful instructions on the part of the test writer.
Scoring can be difficult because of the variety of answers, as well as the
halo effect (students rewarded for strong writing skills as opposed to
demonstrated mastery of the content). Students may also plagiarise
published work and present that as their essay. Currently available software
can be used to screen student essays to deter plagiarism.
c. Most appropriate for:
Assessment that cannot be accomplished with other question types.
Because essays are the only question types that can effectively assess the
highest levels of student mastery, they are the only option if the goal of
testing is the assessment of synthesis and evaluation levels.
Essay questions can be written for all of Bloom's taxonomy, but their true
advantage is the ability to assess the highest levels. Because essay
questions can be time-consuming for student to complete and difficult for
instructors to grade, this question type should be chosen carefully. If the
desired knowledge can be assessed with a different question type, it should
be considered. However, if higher-level processing is a goal of a course (as
it likely will be), well-developed essay questions are the key to accurate
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assessment.
6. Problem based
a. Advantages :
Similar to an essay question can effectively assess all six levels of Blooms
Taxonomy. It is particularly suited to assessing how effectively students can
apply knowledge gained in a novel situation. The students ability to make
effective decisions is assessed and thus it is appropriate to Blooms level 5 &
6 (synthesis and evaluation). For example you can ask a question and the
next question depends upon the answer given to the former. The result is an
assessment based as much on the path taken through the questions as it is
on the final question answer. It can identify if a student can choose a good
strategy or not. You can get the student to enter into a dialogue with the
computer, and record the responses. Time stress can be applied which has
relevance in some areas.
b. Disadvantages :
Difficult questions to write, requiring detailed data/information to be
presented to the student in a structured way. The question is likely to need to
integrate information from several sources and have several pathways
open for the student to choose. (see figure 1)
c. Most appropriate for :
Suited to differential diagnosis of clinical cases. Presenting problem can be
presenting clinical symptoms, which requires provisional diagnosis (possibly
more than one). This needs to be refined by clinical examination and
laboratory tests (pathology, microbiology, biochemistry, histology, ECG,
ultrasound, X ray etc.) The diagnosis once refined may need further tests
before a conclusive diagnosis can be made. This assessment process is
highly relevant to the principles of differential diagnosis and evidence based
medicine.
Once a diagnosis has been made then a suitable treatment needs to be
decided upon and a prognosis made. Each of these steps can be assessed
and ranked in order of importance. Negative marking will be required if an
option is taken which would actually harm the patient.

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d.
Figure 1 Outline of a problem based assessment

Presenting information
which defines the
problem

Provisional hypothesis

Modified hypothesis

Additional information
requested by the student
[To be self selected from
several sources, but which is
ranked in terms of
significance. If inappropriate
or excessive information is
requested then student looses
marks]

Decision
(several options)

Course of action
choice

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7. "Simulation testing"
a. Advantages
Many things we teach actually are high level processes that must be learnt interpreting, translating, writing, manipulating, etc. Simulation of the actual
process can be a powerful tool for facilitating learning, and can be used for
both summative and formative assessment. However the assessment of
these processes can often be difficult and complex. The development of
virtual reality tools and E-learning provides an exciting opportunity to
overcome many of these problems and to be cost effective at the same time.
b. Disadvantages
Simulations can be costly to develop both in staff time and the cost of
appropriate equipment. Currently the aerospace and defence world uses
simulations (flight simulators) as part of both learning and assessment. But
in this very expensive example, it is worth building a simulation because the
cost of making a mistake on a real one is huge. This is not always (often) the
case. There are cheaper ways of simulating however, a good example being
the CD test currently used to test driving students hazard awareness skills.
Another example being developed at Glasgow University is an interactive
model used to test a students ability to pregnancy diagnose a cow.
c. Most appropriate for :
Testing students skills, which currently is often not done because of the
financial cost, demands upon staff time and safety implications.
8. "Performance"
a. Advantages
Almost by definition the performing arts require both formative and
summative assessment tools capable of making judgements about student
learning outcomes based upon a performance or a piece of creative work. Elearning tools such as video or image capture can play an important role in
storing the evidence of student outcomes (on which the assessment is
based) and in supporting formative feedback.
b. Disadvantages
There are few shortcuts for marking performance and elearning tools cannot
automatically mark work as they can for multiple choice type questions for
example. Performance marking can be seen as subjective and the marking
criteria needs to be properly thought out. Performances are ephemeral
events, so unless the performance is captured in some way, (for example
with video recording equipment) the performance is lost. If it is a group
performance, it can be difficult to mark individual students for what is
essentially a group effort.
c. Most appropriate for :
Performance tests practical application of theory and methodology, gauging
creative interpretation of source material. Performance can also test
communication skills, for example in medicine a students ability to
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communicate with patients (often actors) can be assessed. There are

parallels with science practicals, but in arts subjects such as music, it the
performance itself that is assessed, rather than the results of the practical.

The University of Bristol/ILRT has been proactive both in developing itself and in buying in
technologies capable of delivering on-line assessment (see attached appendix 2).
Whatever the decision as to which tools will be chosen for the next step, it will be
important that they can be used to assess all 6 levels of Blooms taxonomy.

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Appendix 1: Examples of CAA

which evaluate differing levels of Blooms taxonomy

LEVEL 1: knowledge/recognition
Question: Newton's three famous laws of motion include these concepts (select three):
1.
2.
3.
4.
5.
6.

Speed
Velocity
Mass
Vector
Energy
Gravity

Question: For each of the following dates, match the event or person associated with it.
Question Items

Answer Items

1. 1066

A. Norman Conquest of Britain

2. 1100s

B. Angkor Wat is built

3. 1215

C. Magna Carta signed

4. 1347

D. Bubonic Plague spreads in Europe

5. 1455

E. Gutenberg's movable-type printing press produces the Bible

6. 1517

F. Martin Luther initiates the Reformation

7. 1664

G. Newton's theory of universal gravitation

8. 1764

H. Mozart (aged 8) writes first symphony

9. 1867

I. Japan ends 675-year shogun rule

10. 1947

J. Gandhi's civil disobedience movement leads to an

independent India

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LEVEL 2: Comprehension
Question:
class is this drug?

1.
2.
3.
4.
5.

Indicate what

Alkyl phenol
Steroidal anaesthetic
Barbiturate
Non-steroidal analgesic
Muscle relaxant

Question: Which of the following statements is correct?

1. stereotypies are repetitive behaviours that develop into redirected behaviours
2. stereotypies sometimes develop from redirected behaviours and approach /
avoidance behaviour
3. apathetic behaviour, redirected behaviour and aggressive behaviour are all
examples of stereotypies
4. stereotypies only develop in animals that have already shown vacuum behaviours

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LEVEL 3 : Application
Question: Indicate what is the effect of this suture pattern on the wound edges

i. Apposes edges
ii. Inverts edges
iii. Relieves tension at edges

Question:
Pet cats show hunting behaviour. According to control theory models of motivation
involving feedback mechanisms, if the functional consequence of this hunting behaviour
(food. is given to the cat, the behaviour should stop.
True or False
Level 3/4 Application/Analysis
The following data were obtained from an experiment in which four diets were fed to
growing rats. Three diets were formulated to contain protein (CP) entirely as casein,
fishmeal or kidney bean meal. The fourth diet was protein-free. Food intake, faecal and
urinary excretion were measured over 5 days. The following results were obtained.

Which diet has the highest true protein digestibilty

1. casein
2. fishmeal
3. kidney bean
Incorrect Answer Feedback

Example of casein

where EFCP = endogenous faecal crude protein

16

Thus casein has the highest true protein digestibility

Question: The following data were obtained from a digestibility trial with growing cattle weighing 300kg .

Nutritive value of food

Dry matter (DM) concentration 0.25
Gross energy (GE)
18.8 MJ/kgDM
Neutral detergent fibre
550g/kgDM
Animal data
Food intake 13.5/kg fresh weight
Faecal output
1.22kgDM/day (GE = 15.2MJ/kgDM)
Urinary output
150gDM/day (GE= 16.1MJ/kgDM)
Methane output
160 litres (STP)/day (GE = 39.5kj/lSTP)
First calculate the ME value in MJ/kgDM of the feed and use it
to calculate the ME intake. Use this value to determine the

Indicate ME intake : ME requirement ratio.

1.5
1.3
1.0
Incorrect Answer Feedback
Diet Metabolisable Energy concentration (MJ/kg/DM) is calculated from

which equals

thus ME concentration = 10.72

ME intake = food intake (fresh) x DM xME concentration
= 13.5 x 0.25 x 10.72 = 36.18
ME requirement = 0.5 x W0.75 = 0.5 x 3000.75 = 36.04
Therefore ME/Mem ration = 36.18/36.04 = 1.0

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LEVEL 4 : Analysis
Question A sow is introduced to another sow on one occasion and shows no oestrous
response but, a few minutes later, shows a strong oestrous response when introduced to
a boar, even though the two are not allowed to mate. The same procedure is followed
again a week later and this time the sow shows no oestrous response to the boar. These
observations indicate that:
1.
2.
3.
4.

oestrous behaviour is controlled by external causal factors only

oestrous behaviour is controlled by internal causal factors only
both external and internal causal factors control oestrous behaviour
the identity of the boar strongly influences whether oestrous behaviour is shown

Question The graph below shows the relationship between levels of stereotypic circling
behaviour and baseline circulating corticosterone observed in 20 randomly selected singly
housed mice.

These results indicate that:

1. Circling behaviour helps the animals to cope with the environment by reducing
stress
2. There is no discernible relationship between circling and corticosterone
3. Corticosterone levels play a causal role in the development of circling behaviour
4. Animals that show high levels of circling may be more stressed
5. High activity could be linked to elevations in corticosterone levels

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LEVEL 4/5 Analysis/synthesis

Question The following results were obtained from routine haematology / biochemistry
(normal ranges appear after each value):
Total protein
Albumin
Potassium
White blood cells
Neutrophils
Haematocrit

60 g/l (57 - 78)

28 g/l (32 - 38)
2.5 mmol/l (3.5 4.5)
4 x10^9/l (6 - 18)
1.5 x10^9/l (3 - 12)
0.58 (0.35 - 0.55)

Which of the following differentials is most likely in this case?

1.
2.
3.
4.
5.

Hepatic failure
Chronic renal failure
Auto immune haemolytic anaemia
Parvovirus infection
Small intestinal foreign body

LEVEL 5/6 Synthesis/Evaluation

Question On day 1 of a study, 6 groups of captive otters (treatment A) are prevented for
swimming for 7 days while 6 other groups are not (treatment B). On day 8, otters in
treatment A are allowed to swim once more. The graph below shows how much time
(mean and standard deviation. otters from the two treatments spent swimming on day 8.
These results indicate that:

1. otters are highly motivated to swim and this motivation accumulates since they last
swam
19

2. otters are motivated to swim

3. deprivation of swimming is stressful for otters
4. the control of otter swimming behaviour is unlikely to be as predicted by Lorenz's
psychohydraulic model

20

Question In an experiment on learning, 10 rats were injected with lithium chloride 2h after
consuming their daily ration of familiar rat pellets. A further 10 rats were handled and given
a sham injection. The rats were then replaced in their individual home cages with ad
libitum familiar rat pellets and water. After 24 h they were given a choice between familiar
rat pellets, and pellets flavoured with a novel but palatable substance. What happens?
1. The lithium chloride stimulates the rats' appetite and the experimental rats eat
more of both types of pellets than control animals.
2. The lithium chloride induces a temporary sickness and a specific food aversion for
the familiar rat pellets is formed. In the test, only novel pellets are consumed.
3. The lithium chloride induces a temporary sickness but no specific food aversion
learning takes place because the pellets were familiar. Rats eat the familiar pellets
in the test.
4. No food aversion learning takes place, because the injection was given 2h after
food consumption. For learning to occur the injection would have had to be given
immediately after food consumption. Rats eat the familiar pellets in the test.
5. The lithium chloride induces a feeling of sickness that persists for 24h. In the test,
nothing is consumed.

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LEVEL 6: Evaluation
This example is produced using CALnet and currently can only be used for instruction
since it does not include the facility for assessment. It is planned to provide this as an
add-on. Basically it consists of a problem solving exercise using clinical material in
this case a horse presenting with symptoms of Colic.
Stepwise the student needs to :
1. make a provisional diagnosis based upon the presenting symptoms
2. carry out a clinical examination by asking pertinent questions of the software.
In the assessed version (to be developed) students will be assessed on the
amount of irrelevant information they request.
Material that can be provided to the student can be quite diverse in its format
including, text, numeric data, audio, pictures and video.
3. make a diagnosis
4. Decide upon treatment
5. Assess likely outcome of the case.
The following screen shots give a flavour of how the case looks for a student.

22

23

24

The following are the answers provided in pop-up boxes when individual
treatments have been selected : Note some are appropriate, others would be bad
news for the case!

25

Analgesia
Analgesia is always indicated in colic to control pain and reduce self-inflicted injury
and exhaustion. The pain of impaction colic tends to be intermittent, so that
analgesics are usually given intermittently to effect.
Prokinetics
Drugs which promote peristalsis are contraindicated because in the presence of an
obstruction they tend to increase pain and, at worst, they may cause gut rupture.
Liquid Paraffin
Liquid paraffin is a mild laxative which softens the mass and lubricates the gut. It is
delivered by nasogastric tube in large volumes, twice daily if necessary, until the
mass starts to break down and liquid paraffin appears in the faeces. Because of its
viscosity it is easier to deliver a suspension of the oil in warm water or 0.9% saline
(50:50 volumes). This may be done under gravity using a funnel or by the cautious
use of a pump. Volume guide: pony 2-3L (total); horse 4-5L; large horse 6-7L.
Intravenous Fluids
Intravenous polyionic fluids may be useful in the first day or two of treatment to
ensure proper hydration of gut tissues. They are positively indicated in dehydrated
patients.
Anthelmintics
An optional treatment but it is unlikely that parasites are implicated here.
Nevertheless, the presence of strongyle larvae and tapeworms may interfere with
normal gut motility. The mare's history recounts use of a proprietary benzimidazole
every six weeks to control alimentary parasites, but at normal therapeutic doses
BMZs are not effective against migrating strongyle larvae or tapeworms. If
considering anthelmintics as part of colic therapy, use products which are effective
against strongyle larvae and tapeworms.
Antibiotics
If the impaction were associated with peritonitis, then antibiotics would be indicated.
However, they are not indicated in the clinical work up of this case.
Teeth rasping
The teeth should be examined as part of the clinical work up. Sharp points on the
cheek teeth can be associated with inadequate chewing of hard feed, which can
predispose or exacerbate impactions. Teeth rasping should be considered.
Pathological changes, particularly vascular compromise of the gut, is reflected in the
colour changes seen in peritoneal fluid. In this case: normal clear yellow fluid

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3. Progress and conclusion of the case

This mare was hospitalised on a bedding of shavings and treated with low doses (onethird doses) of flunixin as required. Five litres of liquid paraffin in warm 0.9% saline were
given twice daily by nasogastric tube. No food was offered for 36 hours, after which wet
bran mashes were given twice daily. After 48 hours scant hard faeces were produced,
followed by a larger volume which was seen to contain liquid paraffin. At this point the
administration of liquid paraffin was stopped and grass was introduced into the diet as a
soft feed. No signs of colic recurred. Two days later the faeces showed an absence of
liquid paraffin and a rectal examination confirmed disappearance of the impaction. Hay
was gradually introduced into the diet over a period of three days, during which time the
mashes were continued to regulate the faecal consistency. Thereafter the usual diet was
introduced and the clients were warned not to use straw bedding again. No further
problems were reported at a six month follow up.

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Appendix 2 : Comparison of various CAA tools

One of the key elements in any eLearning strategy will be the tools to deliver eLearning
programmes or tutorials. A variety has been used within the University to date (and the
following list is not exhaustive) partly because of ad-hoc experimentation but more
importantly due to cost and because one single product has not been found to meet all
needs.
Blackboard - has the all important element of central University support but its
eLearning capabilities consist of the ability to store documents or the means to
deliver quizzes and questionnaires which are limited in their format and content and
which only allow results for the most recently taken quiz to be stored. However,
Blackboard and other popular VLEs do not specifically support eLearning
content creation - merely its delivery (i.e. VLEs, to a large extent, assume a priori
existence of eLearning content).
TAL - is a Bristol-produced computer-based assessment package capable of
producing online and offline tests. The online tests can be authored and delivered
in both Blackboard directly or via CALnet. TAL focuses on summative assessment
and does not allow inclusion of standalone questions inside formative eLearning
content.
CALnet - enables non-technical staff to create interactive eLearning content in the
form of online tutorials that support a much broader pedagogy than the minimal
built-in features of VLEs. However, CALnet currently lacks any form of student
tracking or feedback to the lecturer. CALnet was developed at ILRT and is available
free of charge to University of Bristol staff.
CalScribe - is an offline tutorial authoring tool on top of the commercial off-the-shelf
ToolBook multimedia authoring tool and as such brings a high degree of technical
and pedagogical flexbility but at the unrealistic cost of requiring academics to
become novice programmers. Every user requires a ToolBook licence in order to
use CalScribe. LTSS has helped CalScribe users to switch to CALnet but at the
loss of some authoring features.
WinEcon - eLearning tools built on top of CALnet for the WinEcon II project, feature
richer interaction modes and question types than either CALnet, CalScribe or
Blackboard but currently in a form that is specific to the WinEcon II project; the
WinEcon tools have never been ported back to CALnet for wider use by the
university.
The ideal eLearning tool would include at least the following characteristics:
Free at the point of use to staff and students (at least the perception of being free
for the individuals involved)
Delivered via the Web and usable across all commonly used browsers
Enable creation and deployment of online programmes of work that lead students
through a mixture of text, images (still and moving), links to online resources,
questions and feedback
Provide the option to have questions and quizzes scored and have these results
stored over time
Tutorials/Assessments which are repeatable
o Students can take a tutorial more than once and can compare their scores
o Tutorials can be copied by staff to form the basis of a new tutorial
Allows lecturers to review their students' tutorials/assessment
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 Conform to the emerging standards for interoperability of content (IMS, SCORM)

so that no one is tied to a particularly piece of software as tutorials can be moved
between software packages
Conforms to guidelines and legal requirements for accessibility and usability
Allows local customisation of tutorials to the extent that the look and feel can be
altered to reflect departmental styles but not to the extent that accessibility and
usability are compromised
Adequately supported by online documentation (downloadable documents and/or
online help) for both tutorial authors and students to the extent that direct training
is not required
Can be hosted centrally so that both tutorials and results are held on a secure
server whose data is regularly backed-up
Can be technically supported by the University with no, or very minimal, increase in
IT staff or hardware
Can potentially be linked to University databases (e.g. Datahub for student records)
Ideally within the technical control of University staff (open source / in-house
developed) to better facilitate enhancement and extension of features

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