This unit takes you through the meanings of evaluation, assessment and examination. It provides a set of examples of evaluation tools and it is expected that you can construct evaluation tools for the learners.



Evaluation, Assessment and Examination

The terms evaluation, assessment and examination have been used interchangeably to mean the same thing. However, when examined closely, the terms do not always carry the same meaning.

Evaluation is an encompassing term which includes the functions of examining and assessing. It also includes the aspect of placing a value and making decisions on the data obtained from the examinations.

So, in simple terms, evaluation can be defined as “placing a value on a learner’s performance in order to make decisions about a student, a subject or a course”.

Assessment, on the other hand, is the “method or process of finding out how much a student has learned”. It is the process of determining whether the learners are achieving or have achieved the objectives of a course. This is normally achieved through examinations.

Examinations, then, are the “tools or formal mechanisms which are used to assess the learning of students”.

 Purpose of Evaluating Learners

There are several reasons why students are evaluated. The main ones are:

1. To judge the level of learners’ achievement

2. To predict learners’ future performance

3. To monitor learners’ progress for the purpose of providing feedback

4. To determine teaching effectiveness

5. To license practice of a profession

6. To identify weak and strong areas of a course

7. To grade and rank students for awards.

 Types of Evaluation

We can group the reasons for evaluating learners into two classes: first, those reasons which demand a continuous assessment (formative evaluation), and, second, those ot hers that assist in decision-making at the end of the course (summative e valuation).

Formative evaluation

Also called progressive evaluation, the primary purpose of formative evaluation is to provide feedback to the learner and/or teacher about the learner’s strengths and weaknesses.

Formative evaluation follows small units of learning. The most significant advantage of this kind of evaluation is that it diagnoses learners’ problems early in the instructional process and allows corrective measures to be taken. It carries on throughout the course of study.

Summative evaluation

Summative evaluation is carried out at the end of the term, course or programme. It is also called “terminal evaluation”. It is used mainly for certification, licensing or for selection of learners for a further educational programme.

Note: A good evaluation should include both summative and formative assessment as each has a special role. While formative evaluation gives diagnostic feedback to both teacher and learner over small units of learning, summative evaluation can reveal the student’s ability to integrate and apply learning.

What to Evaluate

Learners, especially potential health workers, should be assessed on what they know (knowledge), what they can do (skills), and what they feel (attitudes) about various issues related to their job.

Assessing Knowledge

Most teachers assess students almost exclusively on their acquisition of knowledge. This assessment usually takes the form of pen and paper tests, such as:

1. Essay tests

2. Short-answer tests

3. Multiple-choice questions (MCQs)

– True/false questions
– Matching questions

– Completion of blanks

The most common paper tests, however, are essays and MCQs.


Essays can be useful methods of student assessment, especially if the y are made valid, reliable and objective.

How to set essay questions

– Decide whether there is no alternative method of assessment.

– Make the qu estion very specific, describing exactly what students should do.

– Prepare a marking scheme.

When writing MCQs, the difficult thing is choosing the question (the stem) and choosing the distractors.

How to choose good questions

Try to make simple, straightforward questions that relate to the teaching you will do. Think of the aspects of the topic that you want to emphasize. Make your questions about those aspects.


A teacher on a refresher course was teaching about diarrhoea. She wanted to emphasize the importance of finding out the causes of diarrhoea. She made these two questions:


When you see a child with diarrhea, what is the first thing to find out: Answer:

a. Whether the child is breast- or bottle-fed

b. Whether the child is at school or not

c. Whether the child is walking or not

d. What the child’s name is?


A mother comes to the clinic complaining that her whole family has diarrhoea. What would you try to find out first?


a. Her husband’s occupation

b. How many members there are in the family?

c. The family’s source of water

d. How many members of the family have been to school?

All the distractors are important. But the teacher wanted to see if her students could pick out the importance of bottle-feeding and the source of water as the cause of diarrhoea.

Another teacher was teaching about control of sexually transmitted diseases. He made these two MCQs:


STDs (Sexually transmitted diseases) can be controlled by:


a. Proper hygiene and early treatment of infected persons

b. Taking capsules before sexual intercourse

c. Taking capsules after sexual intercourse

d. Avoiding prostitutes.


Gonorrhoea can cause:


a. Infertility

b. Madness

c. Deformed legs

d. Loss of hair.

The first question was a good one because it was about the subject. The second question was not a good one for this subject. It does not relate to control of STDs at all. It would have been a good question if the teacher was talking about gonorrhoea itself and the complications of gonorrhoea.

It is good to make the multiple-choice question about an actual situation or an imaginary patient, rather than about a general point. For example, if you want to test how much students know about the treatment of gonorrhoea, which do you think is the better question?


What is the treatment of gonorrhoea?


a. Arsenate

b. Penicillin

c. Chloroquine

d. Flagyl


You see a man who h as a discharge and you diagnose gonorrhoea. What would you give him?


a. Arsenate

b. Penicillin

c. Chloroquine

d. Flagyl

The second question is probabl y etter because the students can relate it to a specific person (in this case,he patient in your question) rather than just a hypothetical situ ation. This kind of question also makes it easier to ask further questions such as:


You see the patient again two weeks later and he still has a discharge. You should:


a. Give him a dose of penicillin

b. Give him a dose of sulfa

c. Do a bacterial culture on the discharge

d. Send him home and tell him not to worry about it. Sometimes you can make this sort of question quite long:


Josephine’s Road-to-Health card shows that she was born in December. She has had only one immunization, the first DPT, given in February. It is now May. What immunizations would you give her at this visit?


a. BCG only

b. BCG and DPT

c. BCG, DPT and polio

d. BCG, DPT, polio and measles. Or even like this:


An outbreak of diarrhoea and vomiting has just been reported to the District Health Education Officer and he immediately comes to you to ask for transport to the area of the outbreak. You, as transport officer in the hospital, start writing (signing) the work ticket for the vehicle. But as you are writing, the District Medical Officer asks for the same vehicle to take him to meet some senior officers from the capital at the airstrip. You would:


a. Give the Medical Officer the vehicle first and ask the District Health Education Officer to make his safari tomorrow.

b. Give the District Health Education Officer the vehicle and look for an alternative vehicle for the doctor to use in meeting the senior officers.

c. Quickly inform all Heads of Departments about the senior officers from the capital and let them meet the senior officers at the airstrip.

d. Keep petrol and drivers ready in case the senior officers want to go round the district.

Such questions can be very useful in provoking the students to think. But remember: If you make a long question, it will take more time for the students to read it and answer it.

How to choose good distractors

Writing good answers is as important as writing good questions. There are three things to remember about choosing distractors:

1. Do not make incorrect answers ridiculous

2. Try to choose distractors from among the sort of mistakes that students commonly make.

3. Do not make the correct answer obvious.

An example of ridiculous wrong answers and an obvious right answer might be like this:


To improve the health of the children in your area which would be the most useful in your dispensary?


a. Ten more staff

b. An ambulance

c. Upgrading to a hospital

d. A fridge and vaccines .

Neither (a), (b) nor (c) is at all possible for a dispensary, so the only possible answer is (d).

Sometimes the correct answer is obvious for other reasons, for example:


The best food for a young child is:


a. Tinned milk

b. Goat’s milk

c. Cow’s milk

d. Breast milk with extra solid food added after the age of four months.

Here, the correct answer is much longer than the distractors, so it stands out from the distractors and the student may choose it for that reason only.

Using common mistakes for distractors can be very effective. Here is a good example:


A child with fever has been admitted to your health centre. He does not seem to have any infection. You have given him chloroquine. What else should you do?


a. Check for dehydration
b. Give antibiotics

c. Refer him to hospital

d. Give aspirin.

Answers (b), (c) and (d) are all common mistakes made at health centres.

Testing different things

You can use MCQs to test different things. Although MCQs only really test knowledge, you can test different sorts of knowledge with them.

For example, this question tests simply what students know about vaccines:


Your kerosene finished last week and your refrigerator has not been working. If you get a new supply of kerosene next month and the refrigerator starts wo rking again, your vaccines:


a. Will all cause bad reactions

b. Will all be effective

c. Will all be useless

d. Will work again after they have been cold for 24 hours.

The question presented earlier, about the vehicle that is needed by the Health Education Officer and the Medical Officer, tests decision-making. There is no absolutely correct answer to that question. It is whatever the student thinks is the best thing to do.

Using MCQs for pre- and post-tests

As we have said, you must make sure that your MCQs are related to your teaching. You can then use them as pre- and post-tests to see how effective your teaching is and whether the students are learning. For example, if you want to teach about treatment of measles, you might give a question like this:


Which drug would you give a child with uncomplicated measles?


a. An antibiotic

b. Chloroquine

c. Stemetil

d. None

Perhaps during the pre-test, most of the students chose answer (a), in your teachin g, then, you emphasize that uncomplicated measles does not need any drugs. If you give the same question in a post-test and everyone chooses (d) this time, you know your teaching has been successful and you have got the point across.

But if only a few choose (d), and many still cho ose (a) or (b) or (c), you know your lesson has not been very successful. You may have to repeat it.

Preparing a marking scheme

There are two ways you could prepare the scheme to make your marking more reliable:

1. Analytic scoring

2. Impression scoring.

In analytic scoring, the examiner sets out a number of crucial points which must appear in the answer.

The student’s answer is then compared to this model answer. Points are then awarded for integration, co-ordination and organization.

In impression marking, the marker simply reads the essay for a general impression of its adequacy. The marker then transforms the impression into a numerical mark and moves on to the next answer. The papers may be sorted out by quality into piles of similar standard before marking.

A useful system could be sorting them into piles of low (25%), middle (50%) and high (25%) score. This is a norm-referenced procedure. It assumes that the ultimate scores will follow a normal distribution. The three major groups could even be sub-divided into lowest (5%), lower (25%), middle (40% ), high (25%), highest (5%).

General rules in marking essay answers

1. Grade answers question by question rather than student by student, i.e. the marker should read one question for all students’ papers before moving on to the next question/paper.

2. Conceal from the marker the name of the student whose paper is being marked.

3. Arrange for independent marking of papers, or at least a sample of them if the class is too large.

4. Discuss the answers with students to ensure learning. Provide feedback! Multiple Choice Questions (MCQS)

What are multiple choice questions?

Multiple choice questions are questions where four or five answers are given and the student has to choose the correct or best answer from them. MCQs have three parts:

1. The question itself, or the stem

2. The correct answer

3. Distractors – these are incorrect answers Examples

Question (stem)

A mother comes to clinic with a malnourished child. What is the most important thing to find out from her?


a. The sex of the child

b. Where the child was born

c. How many children the mother has altogether

d. Whether the child goes to school.

Here, answer (c) is the correct, or best, answer. Answers (a), (b) and (d) are the distractors. It is usually easiest to have one correct answer and three distractors – hence four answers in all. But some people like to have five in all, others only three. It does not really matter how man y you choose.

The question, or stem, need not always be a full question. It could be presented as a statement like this:

Question A mother comes to clinic with a malnourished child. A very important thing to find out is:


a. The sex of the child

b. Where the child was born

c. How many children the mother has altogether

d. Whether the child goes to school

Another example of this sort of question is:


Instruments should be sterilized in containers with:

a. The lid not fitting

b. The lid fitting well

c. No lid at all

d. Just a plastic plate.


This unit provided an in-depth study into evaluation, assessment and examination of learners. The unit also presented an overview o f types of evaluation and how to evaluate. It is hoped that you should be able to construct evaluation tools by now.

Source: School of Education, National Open University of Nigeria


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