Abstract
BackgroundAnalytic thinking skills are important to the development of physicians. Therefore, educators and licensing boards utilize multiple-choice questions (MCQs) to assess these knowledge and skills. MCQs are written under two assumptions: that they can be written as higher or lower order according to Bloom’s taxonomy, and students will perceive questions to be the same taxonomical level as intended. This study seeks to understand the students’ approach to questions by analyzing differences in students’ perception of the Bloom’s level of MCQs in relation to their knowledge and confidence.MethodsA total of 137 students responded to practice endocrine MCQs. Participants indicated the answer to the question, their interpretation of it as higher or lower order, and the degree of confidence in their response to the question.ResultsAlthough there was no significant association between students’ average performance on the content and their question classification (higher or lower), individual students who were less confident in their answer were more than five times as likely (OR = 5.49) to identify a question as higher order than their more confident peers. Students who responded incorrectly to the MCQ were 4 times as likely to identify a question as higher order than their peers who responded correctly.ConclusionsThe results suggest that higher performing, more confident students rely on identifying patterns (even if the question was intended to be higher order). In contrast, less confident students engage in higher-order, analytic thinking even if the question is intended to be lower order. Better understanding of the processes through which students interpret MCQs will help us to better understand the development of clinical reasoning skills.
Highlights
Students may enter medical school equipped with a range of test-taking strategies developed over years of taking multiple choice questions (MCQs) in various settings
Many medical school faculty strive to write multiple-choice questions (MCQs) that entail the application of analytic thinking skills in an effort to model skills needed for clinical reasoning [3, 4]
We evaluate whether students can identify MCQs as requiring higher- or lower-order thinking and the relationship to student performance
Summary
Students may enter medical school equipped with a range of test-taking strategies developed over years of taking multiple choice questions (MCQs) in various settings. They may utilize a variety of approaches such as pattern recognition, buzzword identification, and rote memorization. While memorization of some topics such as anatomy and microbiology is necessary during medical school and in practice, it is not sufficient for the practice of medicine, much less to succeed on most medical school and licensing exams [1] These exams typically require a different approach to test taking that necessitates the use of higher-order thinking skills to apply their underlying knowledge. Better understanding of the processes through which students interpret MCQs will help us to better understand the development of clinical reasoning skills
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