Abstract
BackgroundMultiple-choice questions (MCQ) are still widely used in high stakes medical exams. We wanted to examine whether and to what extent a national licensing exam uses the concept of pattern recognition to test applied clinical knowledge.MethodsWe categorized all 4,134 German National medical licensing exam questions between October 2006 and October 2012 by discipline, year, and type. We analyzed questions from the four largest disciplines: internal medicine (n = 931), neurology (n = 305), pediatrics (n = 281), and surgery (n = 233), with respect to the following question types: knowledge questions (KQ), pattern recognition questions (PRQ), inverse PRQ (IPRQ), and pseudo PRQ (PPRQ).ResultsA total 51.1% of all questions were of a higher taxonomical order (PRQ and IPRQ) with a significant decrease in the percentage of these questions (p <0.001) from 2006 (61.5%) to 2012 (41.6%). The proportion of PRQs and IPRQs was significantly lower (p <0.001) in internal medicine and surgery, compared to neurology and pediatrics. PRQs were mostly used in questions about diagnoses (71.7%). A significantly higher (p <0.05) percentage of PR/therapy questions was found for internal medicine compared with neurology and pediatrics.ConclusionThe concept of pattern recognition is used with different priorities and to various extents by the different disciplines in a high stakes exam to test applied clinical knowledge. Being aware of this concept may aid in the design and balance of MCQs in an exam with respect to testing clinical reasoning as a desired skill at the threshold of postgraduate medical education.
Highlights
Multiple-choice questions (MCQ) are still widely used in high stakes medical exams
knowledge questions (KQ) were identified to constitute the single largest question category (44.3%), while 51.1% of all questions were of a higher taxonomy (PRQ 42.2% and inverse PRQ (IPRQ) 8.9%), and pseudo PRQ (PPRQ) occurred in only 4.6% (Figure 1)
Pattern recognition is a prominent concept in MCQs from a National Medical Licensing Exam to test the application of clinical knowledge
Summary
Multiple-choice questions (MCQ) are still widely used in high stakes medical exams. We wanted to examine whether and to what extent a national licensing exam uses the concept of pattern recognition to test applied clinical knowledge. Multiple-choice questions (MCQs) are still used in high stakes exams worldwide to assess the knowledge of medical students. Even though alternative assessment formats are available and increasingly applied, such as modified essay questions (MEQs) or objective structured clinical exams (OSCEs), the ease of use and testing efficiency of these formats are tempting features for the continued and widespread application of MCQs. In the USA and Germany, for example, MCQs constitute a major part of the National Medical Licensing Exam. Analytical thinking requires feedback [13] and, cannot be applied in MCQ exams in a similar way
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