Abstract
BackgroundClinicians making decisions require the ability to self-monitor and evaluate their certainty of being correct while being mindful of the potential consequences of alternative actions. For clinical students, this ability could be inferred from their responses to multiple-choice questions (MCQ) by recording their certainty in correctness and avoidance of options that are potentially unsafe.MethodsResponse certainty was assessed for fifth year medical students (n = 330) during a summative MCQ examination by having students indicate their certainty in each response they gave on the exam. Incorrect responses were classified as to their inherent level of safeness by an expert panel (response consequence). Analyses compared response certainty, response consequence across student performance groupings.ResultsAs students’ certainty in responses increased, the odds they answered correctly increased and the odds of giving unsafe answers decreased. However, from some ability groups the odds of an incorrect response being unsafe increased with high certainty.ConclusionsCertainty in, and safeness of, MCQ responses can provide additional information to the traditional measure of a number correct. In this sample, even students below standard demonstrated appropriate certainty. However, apart from those scoring lowest, student’s incorrect responses were more likely to be unsafe when they expressed high certainty. These findings suggest that measures of certainty and consequence are somewhat independent of the number of correct responses to MCQs and could provide useful extra information particularly for those close to the pass-fail threshold.
Highlights
Clinicians making decisions require the ability to self-monitor and evaluate their certainty of being correct while being mindful of the potential consequences of alternative actions
Planning this study This study addresses the question of whether, when assessing healthcare professionals or students, there is potential value in considering their demonstration of certainty in responses to questions related to decisionmaking situations and avoidance of responses that would be potentially unsafe in practice [32,33,34]
More than 2/20 highly or moderately unsafe responses that were held with high certainty, irrespective of the number correct
Summary
Clinicians making decisions require the ability to self-monitor and evaluate their certainty of being correct while being mindful of the potential consequences of alternative actions. Effective self-monitoring, evaluation of performance in the moment, along with self-regulation and selfassessment are bases of current professional practice [1,2,3,4,5,6,7] Clinicians consider their decisions regarding whether they need to seek assistance, or additional information, in confirming their decisions [8]. Selfmonitoring of a clinical decision is manifest by considering, “when to look it up” or “defer to others” and is an example of reflection-in-action of daily practice [1, 6, 7, 9] Factors influencing these considerations include beliefs about capabilities, consequences and alternatives [10,11,12]. An inappropriate degree of certainty in a decision, or not considering
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