Assessment of Global Health Education: The Role of Multiple-Choice Questions.

Nathan T Douthit,Igor Waksman,A Mark Clarfield,John Norcini,Seema Biswas,Michael Alkan,Tzvi Dwolatzky,Keren Mazuz,Marie-Therese Feuerstein,Evgeny Solomonov

doi:10.3389/fpubh.2021.640204

Abstract

Introduction: The standardization of global health education and assessment remains a significant issue among global health educators. This paper explores the role of multiple choice questions (MCQs) in global health education: whether MCQs are appropriate in written assessment of what may be perceived to be a broad curriculum packed with fewer facts than biomedical science curricula; what form the MCQs might take; what we want to test; how to select the most appropriate question format; the challenge of quality item-writing; and, which aspects of the curriculum MCQs may be used to assess.Materials and Methods: The Medical School for International Health (MSIH) global health curriculum was blue-printed by content experts and course teachers. A 30-question, 1-h examination was produced after exhaustive item writing and revision by teachers of the course. Reliability, difficulty index and discrimination were calculated and examination results were analyzed using SPSS software.Results: Twenty-nine students sat the 1-h examination. All students passed (scores above 67% - in accordance with University criteria). Twenty-three (77%) questions were found to be easy, 4 (14%) of moderate difficulty, and 3 (9%) difficult (using examinations department difficulty index calculations). Eight questions (27%) were considered discriminatory and 20 (67%) were non-discriminatory according to examinations department calculations and criteria. The reliability score was 0.27.Discussion: Our experience shows that there may be a role for single-best-option (SBO) MCQ assessment in global health education. MCQs may be written that cover the majority of the curriculum. Aspects of the curriculum may be better addressed by non-SBO format MCQs. MCQ assessment might usefully complement other forms of assessment that assess skills, attitude and behavior. Preparation of effective MCQs is an exhaustive process, but high quality MCQs in global health may serve as an important driver of learning.

Highlights

The standardization of global health education and assessment remains a significant issue among global health educators
While other tools including short answer questions, long answer questions, oral examinations, and written reports have an important role in assessment, the vast majority of summative examinations a medical student takes are based on Multiple Choice Questions (MCQs) [1, 3, 4]
Just as the breadth of the biomedical curriculum may be assessed through a single best option (SBO) MCQ, we propose that for substantial areas of the global health curriculum SBO MCQs may be a useful assessment tool

Summary

Introduction

The standardization of global health education and assessment remains a significant issue among global health educators. Multiple Choice Questions (MCQs) are the most commonly used tool for assessment in medical education [1, 2]. While other tools including short answer questions, long answer questions, oral examinations, and written reports have an important role in assessment, the vast majority of summative examinations a medical student takes are based on MCQs [1, 3, 4]. Common criticisms of standard MCQs include their failure to engage higher order thinking, test attitude, behaviors or the application of clinical skills, and their failure to take into account gender and cultural biases in question response. There are, a multitude of MCQ styles that may, to varying degrees, test knowledge, skills, attitudes, judgement and even behavior, especially when questions are context-based

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