Multiple-Choice versus Open-Ended Questions in Advanced Clinical Neuroanatomy: Using a National Neuroanatomy Assessment to Investigate Variability in Performance Using Different Question Types.

Wassim H Merzougui,Matthew A Myers,Rob Parker,Scott Border,Samuel Hall,Ahmad Elmansouri,Oliver Dean,Octavia Kurn,Charlotte H Harrison,Rachel Parrott,Deepika Anbu,Alistair D Robson,Kate Geoghegan

doi:10.1002/ase.2053

Abstract

Methods of assessment in anatomy vary across medical schools in the United Kingdom (UK) and beyond; common methods include written, spotter, and oral assessment. However, there is limited research evaluating these methods in regards to student performance and perception. The National Undergraduate Neuroanatomy Competition (NUNC) is held annually for medical students throughout the UK. Prior to 2017, the competition asked open-ended questions (OEQ) in the anatomy spotter examination, and in subsequent years also asked single best answer (SBA) questions. The aim of this study is to assess medical students' performance on, and perception of, SBA and OEQ methods of assessment in a spotter style anatomy examination. Student examination performance was compared between OEQ (2013-2016) and SBA (2017-2020) for overall score and each neuroanatomical subtopic. Additionally, a questionnaire explored students' perceptions of SBAs. A total of 631 students attended the NUNC in the studied period. The average mark was significantly higher in SBAs compared to OEQs (60.6% vs. 43.1%, P<0.0001)-this was true for all neuroanatomical subtopics except the cerebellum. Students felt that they performed better on SBA than OEQs, and diencephalon was felt to be the most difficult neuroanatomical subtopic (n=38, 34.8%). Students perceived SBA questions to be easier than OEQs and performed significantly better on them in a neuroanatomical spotter examination. Further work is needed to ascertain whether this result is replicable throughout anatomy education.

Highlights

Importance of Anatomy in Undergraduate Medical EducationAnatomy is fundamental within the undergraduate medical education and is strongly associated with clinical competency (Sbayeh et al, 2016)
There were significantly more males in the open-ended questions (OEQ) group than the single best answer (SBA) group (66.4% vs. 55.6%, P = 0.01)
There was no significant difference in the distribution by category between OEQ (57.2% clinical) and SBA (50.1% clinical) groups (P = 0.09)

Summary

Introduction

Importance of Anatomy in Undergraduate Medical EducationAnatomy is fundamental within the undergraduate medical education and is strongly associated with clinical competency (Sbayeh et al, 2016). Medical students consider anatomy teaching an essential part of the medical curriculum and deem it vital for future clinical practice (Ali et al, 2015). Both students themselves and senior NHS clinicians that train them in the workplace report that their anatomical knowledge is insufficient at the point of graduation (Gogalniceanu et al, 2009; Monrouxe et al, 2017; O’Keeffe et al, 2019). This may be due in part to the globally evolving nature of modern curricula where anatomy has featured less heavily over recent decades (Heylings, 2002; Chapman and Hakeem, 2015; Memon, 2018; Trautman et al, 2019). The issue of appropriate assessment strategies is a wider consideration for all disciplines within higher education, and is an area that has been extensively researched

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