* Ain Satar, Paul Winyard, Caroline Fertleman
* Corresponding author: Ain Satar, Institute of Child Health, United Kingdom
n.satar@ucl.ac.uk

Background  
The Institute of Child Health (ICH) runs the first iBSC programme in Paediatrics and Child Health in the world, currently in its ninth year. University College London (UCL) students spend six years in medical school including a compulsory year on iBSc programme. The programme has five modules, each with a variety of assessment approaches. The Child and Community module is partly assessed through a patient/parent information leaflet designed by the students. 

Summary of Work  
The leaflet is submitted alongside a supportive essay justifying their work. Paediatricians and parent markers assess the leaflets on a criterion based mark scheme. The assessment aims to engage students’ higher level thinking skills; encouraging analysis, evaluation and creation. We focus on the application of knowledge, justification of actions and ultimately the development of original work (Anderson, Krathwohl et al, 2001). Although this innovative assessment has many potential benefits, we risk challenging the students beyond their ‘zone of proximal development’ (Vygotsky, 1980). We analysed leaflet marks in comparison to similar pre-seen assignments completed during the year in an effort to modulate and improve its overall utility. 

Summary of Results  
Comparing to other pre-seen assessments, leaflet marks were consistently lower; 17 (85%) students obtained worse marks for leaflet than the mean of three similar assessments (mean difference 6.9%, range 0.3–17.7%). The nearest directly comparable assessment is developing a clinical guideline and when compared to this, the students still scored lower 61% vs 67%. Student feedback highlighted need for more guidance on the principles of leaflet making. Although discovery learning has potential for significant impact on transformative practice, it has to be acknowledged that guided instructions are paramount in fulfilling learning objectives (Alfieri, 2011). In 2018/19, we focussed on leaflet design and construction which was well received (76% rated it 4 or 5 out of 5 with 65% of students completing feedback overall) and resulted in improved performance; thirteen (65%) students performed better compared to mean of three similar assessments (mean difference 2.3%, range 0.3–11.7%). Mean marks for leaflet and guideline assessment were similar in 2018/19 (67% vs 66%). 

Discussion and Conclusion  
Creative design, critical appraisal, conceptualisation and effective communication are skills frequently honed in the years following medical school. Early introduction through assessments such as leaflet design encourages development of a holistic medical professional committed to quality improvement. Medical schools should be preparing future doctors who are able to adapt rapidly to unfamiliar situations. Challenging medical students with novel assessments may increase adaptability as clinicians. However, it must be recognised that students may perform less well in novel assessments given that it is quite disparate from other aspects of medical school assessment. We have found that slight changes in teaching strategy can transform onerous assessments into an enriching learning opportunity. 

Take home messages
Leaflet design as an example of a novel method of assessment in undergraduate medical education. Continued review of performance and feedback help tailor programme development and maximise learning.