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What if I told you about this magical teaching practice that, done even once, produces large improvements in student final exam scores[1], helps narrow the grade gap between poorly prepped and highly prepped first year college students[2], and might even result in more positive course reviews[3],[4]? What if I also told you this magical teaching practice is something you already know how to do? What if I told you, the secret to increasing your students’ success and  overall satisfaction is……more TESTS!?
Okay…well to be fair, it’s a little more nuanced than that. While adding just one test to a class does indeed improve final exam scores, it turns out that more frequent, graded exercises in general improve learning outcomes for students [2],[5]. Even better – if these exercises are low stakes, they can improve learning outcomes without increasing student anxiety [4],[6].
We often view testing as an unpleasant but necessary way to assess student performance. It may be time for us to instead view testing as a useful teaching tool and to implement an assessment system that maximizes the potential learning benefits. In this post I will discuss the important known benefits of frequent, low stakes assessments as well as some practical tips for how to maximize these benefits without adding undue stress to your life or the lives of your students.

Benefit #1: “Thinking about thinking”
Testing can improve a student’s metacognition, or their ability to “think about thinking.” A good metacognitive thinker understands how their thought processes work and can pay attention to and change these processes [7]. A student with strong metacognitive skills can therefore more successfully monitor, evaluate, and improve their learning compared to students lacking these skills. Unfortunately, many students struggle with metacognition and must contend with “illusions of mastery” (or thinking they understand a subject better than they actually do).  Self-testing is a good way to prevent illusions of mastery, but many students do not incorporate self-testing into their studying, instead electing more passive modes of exam preparation such as rereading texts[8]. Incorporating more testing into the curriculum forces students into the position of making mistakes and receiving feedback, allowing them to frequently measure their learning in relation to expectations and adjust accordingly. Again, note that providing feedback is an essential part of this process.

Benefit #2: Practice Remembering
Testing can improve a student’s long term memory of information presented in class by forcing students to recall what they’ve learned through a cognitive process called active retrieval. Active retrieval strengthens neural pathways important for retrieving memories, allowing these memories to be more easily accessed in the future.
While any sort of retrieval practice is useful, it is most beneficial when it is effortful, spaced, and interleaved.  An example of effortful retrieval practice includes testing which forces students to provide the answers (i.e. Short answer and fill in the blank questions as opposed to multiple choice). More effortful retrieval also occurs with spaced and interleaved practice.
Spaced practice is testing that occurs after enough time has elapsed for some (but not complete) forgetting to occur (i.e. Present the information and then wait a couple months, days, or even just until the end of class to test students on it). Interleaved practice incorporates different but related topics and problem types, as opposed to having students practice and master one type at a time (e.g. cumulative testing where you mix problems from different units together). Interleaved practice can help students learn to focus on the underlying principles of problems and to discriminate between problem types, leading to more complex mental models and a deeper understanding of the relationships between ideas[6].

How to Implement More Assessments (Without Losing Your Mind)
So, all you have to do now is come up with a ton of quiz and test questions and free up a bunch of class time for assessments! Don’t forget you also need to grade all of these! After all, feedback is an important part of the process, and frequent (even low stakes) grading has the added benefits of enhancing student motivation, attentiveness, and attendance.I know what you busy teachers (ie. all of you) out there are thinking….“Your ”magical” teaching practice is starting to sound like a hugely effective pain in my butt.”
Don’t give up on me now though! There are some fairly simple ways to add more assessments to your curriculum. Furthermore, you should be able to do this sans student rebellion because these assessments are low-stakes. Frequent, low-stake assessments as opposed to infrequent, high-stakes assessments actually decrease student anxiety overall because no single test is a make it or break it event. In fact, several teachers have reported a large increase in positive student evaluations after restructuring their classes in this way[3],[4],[6]!

Below I lay out some tips for getting the most out of shifting your assessment practices while maintaining both your own and your students’ sanity:

1) Know that “effortful” testing is not always necessary
While effortful testing is best for retrieval practice, even basic, easily graded recognition tests such multiple choice questions still offer benefits, such as helping students remember basic (but important!) information[6],[9].

2) Create different assessment questions
You can also make assessments more effortful by creating questions that engage higher cognitive processes. Now you can sit back, relax, and indulge in one of my personal favorite pastimes (watching student brains explode) without the stressful grading!

3) Make use of educational technologies to ease your grading
For instance, clicker tests are a quick way to test students and allow you to provide feedback for the class all at once.

4) Make assessments into games
If your students need a morale boost, make a quiz into a trivia game and give winning groups candy. Some good old competition and Pavlovian conditioning may make students reassess their view of testing.

5) Assess participation
Doing something as simple as a participation grade will still provide students with incentive without overburdening them or yourself. For instance, this type of grading would work in conjunction with #3.

6) Keep graded assessments predictable
Making assessments predictable as opposed to utilizing pop quizzes helps students feel at ease.6 Furthermore, if they students KNOW an assessment is coming, they are more likely to study and pay attention.

7) Find ways to revisit old material in your assessments
Making assessments cumulative is an effective way to space out your review of material and has the added benefit of making problems interleaved and effortful, all of which maximize retrieval practice[6].

8) Have students reflect on mistakes
You can help students develop metacognitive skills by giving them opportunities to reflect upon and correct their mistakes on assessments. For instance, have students take a quiz and then discuss their answers/thinking with their classmates before receiving feedback. You can also give students opportunities to create keys to short answer questions and grade their own and several (anonymous) classmates’ answers. This will allow them to think through what makes an answer complete and effective.

9) Break large assessments into small ones
Instead of creating new assessments, break up large ones into multiple, lower-stakes assessments. For example, consider replacing big tests with several quizzes. Consider scaffolding large projects such as independent research projects and term papers. Ask for outlines, lists of references, graphs, etc. along the course of the semester before the final project is due. This might cause more work for you in the short term but can help prevent complete disasters at the end of the semester, which can be time consuming.

10) Utilize short daily or weekly quizzes
If you don’t want to adjust a big project/test or lose class time by adding time-consuming assessments, consider adding short daily or weekly quizzes. These grades can add up to equal one test grade. One could consider dropping the lowest score(s) but allowing no make ups to reduce logistical issues.
These are only a few of the many strategies one can use to transition to a frequent, low-stakes assessment system. What are your experiences with low stakes assessments? Have you made use of any which seem particularly effective in enhancing student learning?

Related Reading:
Much of the information about the benefits of testing is from:
Brown, P.C., Roediger III, H.L., McDaniel, M.A. (2014). Make it Stick: The Science of Successful Learning. Cambridge, MA: The Belknap Press of Harvard University Press.

https://www.youtube.com/watch?v=L-VBVLQRmmw

As globalization of the world economy continues unabated, a parallel growth of globalization of knowledge is also taking place. This latter trend is little affected by the boundaries between developed and less developed countries and is having a particular impact on trends in education. This article looks at the impact of globalization within the context of education in South Africa. It focuses on different perspectives of globalization and identifies key factors that may have an impact on education in South Africa. Finally, it argues that in order to respond to the dangers of marginalization posed by globalization it will be crucial to form, and be part of, new alliances and networks. These will both provide opportunities for sharing knowledge and skills and also build economic strength.

Does this test have other names?
ESR, sed rate
What is this test?
Erythrocyte sedimentation rate (ESR) is a blood test. It measures how quickly erythrocytes, or red blood cells, separate from a blood sample that has been treated so the blood will not clot. During this test, a small amount of your blood will be put in an upright tube. A lab specialist will measure the rate that your red blood cells settle toward the bottom of the tube after 1 hour.
If you have a condition that causes inflammation or cell damage, your red blood cells tend to clump together. This makes them heavier, so they settle faster. The faster your red blood cells settle and fall, the higher your ESR. A high ESR tells your healthcare provider that you may have an active disease process in your body.
Why do I need this test?
You may need this test if you have symptoms of one of the diseases that may cause ESR to go up.
You may also need this test if you have already been diagnosed with a disease that causes a high ESR. The test can allow your healthcare provider to see how well you are responding to treatment.
The ESR blood test is most useful for diagnosing or monitoring diseases that cause pain and swelling from inflammation. Other symptoms may include fever and weight loss. These diseases include:


Temporal arteritis


Rheumatoid arthritis


Polymyalgia rheumatica


ESR is not used as a screening test in people who do not have symptoms or to diagnose disease because many conditions can cause it to increase. It might also go up in many normal cases. ESR doesn't tell your healthcare provider whether you have a specific disease. It only suggests that you may have an active disease process in your body.
What other tests might I have along with this test?
You may have other tests if your healthcare provider is doing this test to diagnose a disease. One of these tests is called a C-reactive protein test, or CRP. This test also measures active inflammation in the body.
Your healthcare provider may do an ESR alone if they are monitoring a disease you already have.
Because ESR tells your healthcare provider only what is happening right now, you may need to have the test repeated over time.
What do my test results mean?
Test results may vary depending on your age, gender, health history, and other things. Your test results may be different depending on the lab used. They may not mean you have a problem. Ask your healthcare provider what your test results mean for you.
ESR is measured in millimeters per hour (mm/hr). The normal values are:


0 to 15 mm/hr in men


0 to 20 mm/hr in women


ESR above 100 mm/h is most likely caused by an active disease. For instance, you may have:


A disease that causes inflammation in your body


An active infection


Cancer


Heart disease


Kidney disease


Blood disease


Diabetes


Collagen vascular disease


How is this test done?
The test is done with a blood sample. A needle is used to draw blood from a vein in your arm or hand.
Does this test pose any risks?
Having a blood test with a needle carries some risks. These include bleeding, infection, bruising, and feeling lightheaded. When the needle pricks your arm or hand, you may feel a slight sting or pain. Afterward, the site may be sore.
What might affect my test results?
Many things that are not active diseases can increase your ESR. These include:


Pregnancy


Old age


Being female


Having a menstrual period


Having recently eaten a fatty meal


Being obese


Taking certain medicines


How do I get ready for this test?
You don't need to prepare for this test. Be sure your healthcare provider knows about all medicines, herbs, vitamins, and supplements you are taking. This includes medicines that don't need a prescription and any illegal drugs you may use. Tell your healthcare provider if you ate a fatty meal recently, if you are having your period, or if you may be pregnant.

Medical Reviewers:

Chad Haldeman-Englert MD
Raymond Turley Jr PA-C
Tara Novick BSN MSN

Department of Haematology
Notes

Full blood counts are performed on automated equipment and provide haemoglobin concentration, red cell indices, white cell count (with a differential count) and platelet count.
The presence of abnormal white cell and red cell morphology is flagged by the analysers.
Blood films may be inspected to confirm and interpret abnormalities identified by the cell counter, or to look for certain specific haematological abnormalities.
Grossly abnormal FBC results and abnormal blood films will be phoned through to the requestor.
There is no need to request a blood film to obtain a differential white count. It is, however, important that clinical details are provided to allow the laboratory to decide whether a blood film, in addition to the automated analysis, is required.
Under some circumstances a differential is not routinely performed, e.g. pre-op, post-op, antenatal and postnatal requests.
Full Blood Counts are performed at CGH and GRH
See also: Reticulocyte Count

The FBC comprises the following tests
Standard

Haemoglobin (Hb)
White Blood Count (WBC)
Platelet Count (Plt)
Red Cell Count (RBC)
Haematocrit (HCT)
Mean Cell Volume - Red cell (MCV)
Mean Cell Haemoglobin (MCH)

Differential White Cell Count (where applicable)

Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils

And if appropriate

Blood Film

Sample Requirements
2ml or 4ml EDTA sample or a Paediatric 1ml EDTA sample.

 

Sample Storage and Retention

Pre analysis storage: do not store, send to laboratory within 4 hours.
Sample retention by lab: EDTA samples are retained for a minimum of 48 hours at 2-10°C
Transport of samples may affect sample viability, i.e. FBC results will degenerate if exposed to high temperatures, such as prolonged transportation in a hot car in summer.

This test can be added on to a previous request as long as there is sufficient sample remaining and the sample is less than 24 hours old.
Turnaround Times

Clinical emergency: 30 mins
Other urgent sample: 60 mins
Routine: within 2 hours

Reference Ranges


If references ranges are required for paediatric patients please contact the laboratory for these.

Parameter Patient Reference Range Units Haemoglobin Adult Male 130 - 180 g/L   Adult Female 115 - 165 g/L Red Cell Count Adult Male 4.50 - 6.50 x10^12/L   Adult Female 3.80 - 5.80 x10^12/L Haematocrit Adult Male 0.40 - 0.54 L/L   Adult Female 0.37 - 0.47 L/L Mean Cell Volume Adult 80 - 100 fL Mean Cell Haemoglobin Adult 27 - 32 pg White Cell Count Adult 3.6 - 11.0 x10^9/L Neutrophils Adult 1.8 - 7.5 x10^9/L Lymphocytes Adult 1.0 - 4.0 x10^9/L Monocytes Adult 0.2 - 0.8 x10^9/L Eosinophils Adult 0.1 - 0.4 x10^9/L Basophils Adult 0.02 - 0.10 x10^9/L Platelet Count Adult 140 - 400 x10^9/L


 




 

Department of Haematology
Notes

Full blood counts are performed on automated equipment and provide haemoglobin concentration, red cell indices, white cell count (with a differential count) and platelet count.
The presence of abnormal white cell and red cell morphology is flagged by the analysers.
Blood films may be inspected to confirm and interpret abnormalities identified by the cell counter, or to look for certain specific haematological abnormalities.
Grossly abnormal FBC results and abnormal blood films will be phoned through to the requestor.
There is no need to request a blood film to obtain a differential white count. It is, however, important that clinical details are provided to allow the laboratory to decide whether a blood film, in addition to the automated analysis, is required.
Under some circumstances a differential is not routinely performed, e.g. pre-op, post-op, antenatal and postnatal requests.
Full Blood Counts are performed at CGH and GRH
See also: Reticulocyte Count

The FBC comprises the following tests
Standard

Haemoglobin (Hb)
White Blood Count (WBC)
Platelet Count (Plt)
Red Cell Count (RBC)
Haematocrit (HCT)
Mean Cell Volume - Red cell (MCV)
Mean Cell Haemoglobin (MCH)

Differential White Cell Count (where applicable)

Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils

And if appropriate

Blood Film

Sample Requirements
2ml or 4ml EDTA sample or a Paediatric 1ml EDTA sample.

 

Sample Storage and Retention

Pre analysis storage: do not store, send to laboratory within 4 hours.
Sample retention by lab: EDTA samples are retained for a minimum of 48 hours at 2-10°C
Transport of samples may affect sample viability, i.e. FBC results will degenerate if exposed to high temperatures, such as prolonged transportation in a hot car in summer.

This test can be added on to a previous request as long as there is sufficient sample remaining and the sample is less than 24 hours old.
Turnaround Times

Clinical emergency: 30 mins
Other urgent sample: 60 mins
Routine: within 2 hours

Reference Ranges


If references ranges are required for paediatric patients please contact the laboratory for these.

Parameter Patient Reference Range Units Haemoglobin Adult Male 130 - 180 g/L   Adult Female 115 - 165 g/L Red Cell Count Adult Male 4.50 - 6.50 x10^12/L   Adult Female 3.80 - 5.80 x10^12/L Haematocrit Adult Male 0.40 - 0.54 L/L   Adult Female 0.37 - 0.47 L/L Mean Cell Volume Adult 80 - 100 fL Mean Cell Haemoglobin Adult 27 - 32 pg White Cell Count Adult 3.6 - 11.0 x10^9/L Neutrophils Adult 1.8 - 7.5 x10^9/L Lymphocytes Adult 1.0 - 4.0 x10^9/L Monocytes Adult 0.2 - 0.8 x10^9/L Eosinophils Adult 0.1 - 0.4 x10^9/L Basophils Adult 0.02 - 0.10 x10^9/L Platelet Count Adult 140 - 400 x10^9/L


 




 

Department of Haematology
Notes

Full blood counts are performed on automated equipment and provide haemoglobin concentration, red cell indices, white cell count (with a differential count) and platelet count.
The presence of abnormal white cell and red cell morphology is flagged by the analysers.
Blood films may be inspected to confirm and interpret abnormalities identified by the cell counter, or to look for certain specific haematological abnormalities.
Grossly abnormal FBC results and abnormal blood films will be phoned through to the requestor.
There is no need to request a blood film to obtain a differential white count. It is, however, important that clinical details are provided to allow the laboratory to decide whether a blood film, in addition to the automated analysis, is required.
Under some circumstances a differential is not routinely performed, e.g. pre-op, post-op, antenatal and postnatal requests.
Full Blood Counts are performed at CGH and GRH
See also: Reticulocyte Count

The FBC comprises the following tests
Standard

Haemoglobin (Hb)
White Blood Count (WBC)
Platelet Count (Plt)
Red Cell Count (RBC)
Haematocrit (HCT)
Mean Cell Volume - Red cell (MCV)
Mean Cell Haemoglobin (MCH)

Differential White Cell Count (where applicable)

Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils

And if appropriate

Blood Film

Sample Requirements
2ml or 4ml EDTA sample or a Paediatric 1ml EDTA sample.

 

Sample Storage and Retention

Pre analysis storage: do not store, send to laboratory within 4 hours.
Sample retention by lab: EDTA samples are retained for a minimum of 48 hours at 2-10°C
Transport of samples may affect sample viability, i.e. FBC results will degenerate if exposed to high temperatures, such as prolonged transportation in a hot car in summer.

This test can be added on to a previous request as long as there is sufficient sample remaining and the sample is less than 24 hours old.
Turnaround Times

Clinical emergency: 30 mins
Other urgent sample: 60 mins
Routine: within 2 hours

Reference Ranges


If references ranges are required for paediatric patients please contact the laboratory for these.

Parameter Patient Reference Range Units Haemoglobin Adult Male 130 - 180 g/L   Adult Female 115 - 165 g/L Red Cell Count Adult Male 4.50 - 6.50 x10^12/L   Adult Female 3.80 - 5.80 x10^12/L Haematocrit Adult Male 0.40 - 0.54 L/L   Adult Female 0.37 - 0.47 L/L Mean Cell Volume Adult 80 - 100 fL Mean Cell Haemoglobin Adult 27 - 32 pg White Cell Count Adult 3.6 - 11.0 x10^9/L Neutrophils Adult 1.8 - 7.5 x10^9/L Lymphocytes Adult 1.0 - 4.0 x10^9/L Monocytes Adult 0.2 - 0.8 x10^9/L Eosinophils Adult 0.1 - 0.4 x10^9/L Basophils Adult 0.02 - 0.10 x10^9/L Platelet Count Adult 140 - 400 x10^9/L

Department of Haematology
Notes

Full blood counts are performed on automated equipment and provide haemoglobin concentration, red cell indices, white cell count (with a differential count) and platelet count.
The presence of abnormal white cell and red cell morphology is flagged by the analysers.
Blood films may be inspected to confirm and interpret abnormalities identified by the cell counter, or to look for certain specific haematological abnormalities.
Grossly abnormal FBC results and abnormal blood films will be phoned through to the requestor.
There is no need to request a blood film to obtain a differential white count. It is, however, important that clinical details are provided to allow the laboratory to decide whether a blood film, in addition to the automated analysis, is required.
Under some circumstances a differential is not routinely performed, e.g. pre-op, post-op, antenatal and postnatal requests.
Full Blood Counts are performed at CGH and GRH
See also: Reticulocyte Count

The FBC comprises the following tests
Standard

Haemoglobin (Hb)
White Blood Count (WBC)
Platelet Count (Plt)
Red Cell Count (RBC)
Haematocrit (HCT)
Mean Cell Volume - Red cell (MCV)
Mean Cell Haemoglobin (MCH)

Differential White Cell Count (where applicable)

Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils

And if appropriate

Blood Film

Sample Requirements
2ml or 4ml EDTA sample or a Paediatric 1ml EDTA sample.

 

Sample Storage and Retention

Pre analysis storage: do not store, send to laboratory within 4 hours.
Sample retention by lab: EDTA samples are retained for a minimum of 48 hours at 2-10°C
Transport of samples may affect sample viability, i.e. FBC results will degenerate if exposed to high temperatures, such as prolonged transportation in a hot car in summer.

This test can be added on to a previous request as long as there is sufficient sample remaining and the sample is less than 24 hours old.
Turnaround Times

Clinical emergency: 30 mins
Other urgent sample: 60 mins
Routine: within 2 hours

Reference Ranges


If references ranges are required for paediatric patients please contact the laboratory for these.

Parameter Patient Reference Range Units Haemoglobin Adult Male 130 - 180 g/L   Adult Female 115 - 165 g/L Red Cell Count Adult Male 4.50 - 6.50 x10^12/L   Adult Female 3.80 - 5.80 x10^12/L Haematocrit Adult Male 0.40 - 0.54 L/L   Adult Female 0.37 - 0.47 L/L Mean Cell Volume Adult 80 - 100 fL Mean Cell Haemoglobin Adult 27 - 32 pg White Cell Count Adult 3.6 - 11.0 x10^9/L Neutrophils Adult 1.8 - 7.5 x10^9/L Lymphocytes Adult 1.0 - 4.0 x10^9/L Monocytes Adult 0.2 - 0.8 x10^9/L Eosinophils Adult 0.1 - 0.4 x10^9/L Basophils Adult 0.02 - 0.10 x10^9/L Platelet Count Adult 140 - 400 x10^9/L

Department of Haematology
Notes

Full blood counts are performed on automated equipment and provide haemoglobin concentration, red cell indices, white cell count (with a differential count) and platelet count.
The presence of abnormal white cell and red cell morphology is flagged by the analysers.
Blood films may be inspected to confirm and interpret abnormalities identified by the cell counter, or to look for certain specific haematological abnormalities.
Grossly abnormal FBC results and abnormal blood films will be phoned through to the requestor.
There is no need to request a blood film to obtain a differential white count. It is, however, important that clinical details are provided to allow the laboratory to decide whether a blood film, in addition to the automated analysis, is required.
Under some circumstances a differential is not routinely performed, e.g. pre-op, post-op, antenatal and postnatal requests.
Full Blood Counts are performed at CGH and GRH
See also: Reticulocyte Count

The FBC comprises the following tests
Standard

Haemoglobin (Hb)
White Blood Count (WBC)
Platelet Count (Plt)
Red Cell Count (RBC)
Haematocrit (HCT)
Mean Cell Volume - Red cell (MCV)
Mean Cell Haemoglobin (MCH)

Differential White Cell Count (where applicable)

Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils

And if appropriate

Blood Film

Sample Requirements
2ml or 4ml EDTA sample or a Paediatric 1ml EDTA sample.

 

Sample Storage and Retention

Pre analysis storage: do not store, send to laboratory within 4 hours.
Sample retention by lab: EDTA samples are retained for a minimum of 48 hours at 2-10°C
Transport of samples may affect sample viability, i.e. FBC results will degenerate if exposed to high temperatures, such as prolonged transportation in a hot car in summer.

This test can be added on to a previous request as long as there is sufficient sample remaining and the sample is less than 24 hours old.
Turnaround Times

Clinical emergency: 30 mins
Other urgent sample: 60 mins
Routine: within 2 hours

Reference Ranges


If references ranges are required for paediatric patients please contact the laboratory for these.

Parameter Patient Reference Range Units Haemoglobin Adult Male 130 - 180 g/L   Adult Female 115 - 165 g/L Red Cell Count Adult Male 4.50 - 6.50 x10^12/L   Adult Female 3.80 - 5.80 x10^12/L Haematocrit Adult Male 0.40 - 0.54 L/L   Adult Female 0.37 - 0.47 L/L Mean Cell Volume Adult 80 - 100 fL Mean Cell Haemoglobin Adult 27 - 32 pg White Cell Count Adult 3.6 - 11.0 x10^9/L Neutrophils Adult 1.8 - 7.5 x10^9/L Lymphocytes Adult 1.0 - 4.0 x10^9/L Monocytes Adult 0.2 - 0.8 x10^9/L Eosinophils Adult 0.1 - 0.4 x10^9/L Basophils Adult 0.02 - 0.10 x10^9/L Platelet Count Adult 140 - 400 x10^9/L