Answer Multiple Choice Questions Research Articles

Enhancing Dental Education: Impact of Remote Teaching on Dental Students' Academic Performance in Orthodontics-A Pilot Study.

Remote teaching strategies have been widely adapted in recent years but their impact on dental students' learning outcomes is less well understood. The aim of this mixed-method pilot study was to examine the impact of remote teaching on undergraduate dental student's learning outcome as assessed by examination performance and student feedback in an orthodontics course. Out of the lectures (19 in total), 10 were delivered remotely (live online lecture or video recording) and 9 as traditional classroom teaching in 2023. The course examination, completed by 47 of the 48 course participants, consisted of 38 single best answer multiple choice questions with 2 questions dedicated to each lecture topic. The average lecture attendance was 83% of the students enrolled in the course. Statistical analysis revealed no significant association between examination scores and the mode of teaching or the mandatory nature of the lecture (rs = -0.022, p = .897 and rs = -0.048, p = .773, respectively). However, individual students' examination scores correlated positively with the frequency of lecture attendance (rs = 0.416, p = .004). Students' preferences were in favor of blended learning approach, although notable individual differences in opinions were observed in the feedback received. The findings of this study support the hypothesis that remote teaching generates an equally good learning outcome in orthodontics as classroom lectures, as reflected by examination performance.

A randomised control trial study on the efficacy of high-fidelity simulation in enhancing knowledge

Introduction: The practice of high-fidelity simulation-based medical education has become a popular small-group teaching modality across all spheres of clinical medicine. High-fidelity simulation (HFS) is now being increasingly used in the context of undergraduate medical education, but its superiority over traditional teaching methods is still not established. The main objective of this study was to analyse the effectiveness of HFS-based teaching over video-assisted lecture (VAL)-based teaching in the enhancement of knowledge for the management of tension pneumothorax among undergraduate medical students. Methods: A cohort of 111 final-year undergraduate medical students were randomised for this study. The efficacy of HFS-based teaching (intervention group) and VAL-based teaching (control group), on the acquisition of knowledge, was assessed by single-best answer multiple choice questions (MCQ) tests in the first and eighth week of their surgery posting. Mean and standard deviation (SD) for the total score of MCQ assessments were used as outcome measures. ANCOVA was used to determine the difference in post-test MCQ marks between groups. The intragroup comparison of the pre-test and post-test MCQ scores was done by using paired t-test. The P-value was set at 0.05. Results: The mean of post-test MCQ scores were significantly higher than the mean of pre-test MCQ scores in both groups. The mean pre-test and post-test MCQ scores in the intervention group were slightly more than those of the control group but not statistically significant. Conclusion: There was a statistically significant enhancement of knowledge in both groups but the difference in knowledge enhancement between the groups was insignificant.

Twine virtual patient games as an online resource for undergraduate diabetes acute care education

BackgroundVirtual patients provide a safe way to simulate authentic clinical practice. Twine is an open-source software that can be used to create intricate virtual patient games, including elements like non-linear free text history taking and time-related changes to the game’s narrative. We evaluated the incorporation of Twine virtual patient games into a diabetes acute care online learning package for undergraduate medical students at the University of Glassgow, Scotland.MethodsThree games were developed using Twine, Wacom Intuous Pro, Autodesk SketchBook, Camtasia Studio, and simulated patients. Online material included three VP games, eight microlectures, and a single best answer multiple choice question quiz. The games were evaluated at Kirkpatrick Level 1 with an acceptability and usability questionnaire. The entire online package was evaluated at Kirkpatrick Level 2 with pre- and post-course multiple choice and confidence questions, with statistical analysis performed using paired t-tests.Results122 of approximately 270 eligible students provided information on resource utilisation, with 96% of these students using at least one online resource. 68% of students who returned surveys used at least one VP game. 73 students provided feedback on the VP games they had played, with the majority of median responses being “agree” on positive usability and acceptability statements. The online resources were associated with a mean multiple choice score increase from 4.37 out of 10 to 7.96 out of 10 (p < 0.0001, 95% CI + 2.99 to + 4.20, n = 52) and a mean total confidence score increase from 4.86 out of 10 to 6.70 out of 10 (p < 0.0001, 95% CI + 1.37 to + 2.30, n = 48).ConclusionsOur VP games were well-received by students and promoted engagement with online material. The package of online material led to statistically significant increases in confidence and knowledge in diabetes acute care outcomes. A blueprint with supporting instructions has now been created to facilitate rapid creation of further games using Twine software.

Answering questions in a co-created formative exam question bank improves summative exam performance, while students perceive benefits from answering, authoring, and peer discussion: A mixed methods analysis of PeerWise.

Multiple choice questions (MCQs) are a common form of assessment in medical schools and students seek opportunities to engage with formative assessment that reflects their summative exams. Formative assessment with feedback and active learning strategies improve student learning outcomes, but a challenge for educators, particularly those with large class sizes, is how to provide students with such opportunities without overburdening faculty. To address this, we enrolled medical students in the online learning platform PeerWise, which enables students to author and answer MCQs, rate the quality of other students’ contributions as well as discuss content. A quasi‐experimental mixed methods research design was used to explore PeerWise use and its impact on the learning experience and exam results of fourth year medical students who were studying courses in clinical sciences and pharmacology. Most students chose to engage with PeerWise following its introduction as a noncompulsory learning opportunity. While students perceived benefits in authoring and peer discussion, students engaged most highly with answering questions, noting that this helped them identify gaps in knowledge, test their learning and improve exam technique. Detailed analysis of the 2015 cohort (n = 444) with hierarchical regression models revealed a significant positive predictive relationship between answering PeerWise questions and exam results, even after controlling for previous academic performance, which was further confirmed with a follow‐up multi‐year analysis (2015–2018, n = 1693). These 4 years of quantitative data corroborated students’ belief in the benefit of answering peer‐authored questions for learning.

Flipping a biochemistry class within a medical curriculum: Impacts on perception, engagement, and attainment.

The flipped classroom has gained prominence in higher education, but little has been written about its application in the Middle East. This study aimed to assess the feasibility, acceptability, and impact of flipping biochemistry classes in comparison to the traditional didactic program. The study was conducted on first-year medical students taking biochemistry at a private University in Saudi Arabia. A series of short, pre-recorded videos were used to replace traditional lectures. The scheduled lecture time was used for problem solving and discussion sessions. To gather their evaluation of the learning approach, participants completed an online survey. To study the effect of the learning approach on exam performance, the scores of the participants were compared in questions taught using the flipped classroom versus the traditional didactic method. Participants noted that the effort needed for the course was similar regardless of the learning approach. Moreover, examination performance measured using single best answer multiple-choice questions showed no difference between the two teaching methods. However, the participants did report a significantly better perception of the flipped classroom compared to the traditional approach. Although no significant improvement in examination results was noted, the participants significantly favored the flipped classroom over traditional lectures. This study has demonstrated that the flipped classroom can be used in the teaching of the biosciences within a Middle Eastern setting, resulting in an improvement in student satisfaction and engagement in the course materials.

Virtual Classrooms during the Covid-19 pandemic

In order to contain the virus, lockdown was imposed and as a consequence, education delivery methods have changed drastically, with e-learning progressively identifiable, and teaching being carried out with the help of digital platforms.Teachers are struggling with Zoom and Google classrooms to teach students. The conventional style of lectures is deemed incompetent and has been criticized for its inadequacy in involving students, now the focus has been diverted on more innovative pedagogical methods, such as group training, peer interaction and integrated or 'flipped' learning. These practices can continue on-line and can help to develop and expand the interest of students. Multiple IT tools can now be incorporated as a teaching strategy so that Professors and teachers, rather than emphasizing on the classical lecture format, can bring innovation and interactivity to their teaching.One of a very basic and interesting tool is Interactive Video. It allows teachers to enable students to practice questions and discussions while watching videos, by marking signs at specific moments during that video. Mostly the topics are previously taught so it`s easy for a student to understand the lesson. Students can even return back and watch the same video again, in order to develop thorough understanding of a topic. The performance of each student can be evaluated and this approach keeps track of their problems and the topics which are harder to understand. The students stay motivated as the feedback is instant and timely. May educators take Quizzes as standard in classrooms, This learning format develops variety of discussion and suggestions.Apps like Kahoot, Socrative, Quizlet can result in effective classroom engagement. These apps when assigned, allow teachers to test understanding of students simultaneously. Quizzes may be in the form of open-ended short questionnaires, short answer question, true-false, or multiple choice questions. When the quiz is created by the educator and displayed, students can either use their laptops, computers or phones to respond. This is a synchronous type of interaction, where the teachers screen is displaying the questions, and students have to reply through their own devices.It is difficult to engage students during online classes and this issue need to be resolved. If such an approach is adopted which highlight students perspective into consideration rather than trying to accomplish a fake on-campus experience online. Novel methods to teach using digital technology compliments the teaching system and adds creativity. The concept of virtual classroom is potentially off-putting and unfamiliar for new students, studying online for the first time. There are multiple factors influencing the engagement and involvement of students in online system of teaching: it includes family of students due to which students are distracted and focus less during online sessions, additionally, there may be lack of proper technical facilities i.e they may either have no digital facility or older and slower versions which make it difficult for students to understand during the online classes.

Abstract 233: Quality of Collaboration Between Cardiologists and Internists During Inpatient Consultations

Background: Collaboration between cardiologists and internists is essential to providing safe, effective, and patient-centered cardiovascular care. The objective of this study was to determine the quality of collaboration between these clinicians during inpatient consultations and identify areas for improvement. Methods: We surveyed hospitalists, general internal medicine faculty, and resident physicians from inpatient general medicine services and consulting cardiology attendings and fellows at a large tertiary care hospital over a two month period. Respondents were asked to rate each other’s level of collaboration on a 5-point ordinal response scale and answer multiple choice and free-response questions on consultation practices and personal preferences. Results: Overall, 92 of 155 (59%) eligible hospitalists, general internal medicine faculty, and resident physicians completed the primary survey. Collaboration with cardiology consultants was rated as high or very high quality by 72% of respondents. There was no significant difference between ratings of collaboration quality based on respondents’ level of training. Internists identified resistance or disagreement with indication for consultation, difficulty receiving a timely response, and poor follow-up communication as the largest barriers to high quality collaboration. Most internists preferred receiving recommendations by page, phone, or written in a consult note, rather than in person. Internists appreciated close communication throughout the consultation process. For longitudinal consultations, internists preferred when an intention to sign-off was communicated by page or wrote in that day’s consult note. In total, 9 cardiology attendings and fellows completed the specialty survey. Cardiologists reported providing recommendations the same day for routine consultations, or within 2-3 hours when urgent. Most consultants communicated their recommendations thru page, phone conversations, or written consult note. Providing recommendations in person was rare. Half of cardiology attendings and fellows rated collaboration with internists as high or very high quality. There was no significant difference between their ratings of collaboration with hospitalists and residents. Cardiologists appreciated when outside hospital records had already been obtained. They identified receiving an unclear reason for consult, consulting prior to initial work-up, late in the day, or when an outpatient appointment was more appropriate as the largest barriers to high quality collaboration. Conclusions: While cardiologists and internists appear to agree on modes of communication, they have different perceptions of timeliness and disagreements on appropriateness of consultations. Further research is needed to design and study interventions that address these barriers to high quality collaboration.

Think Twice: Effects on Diagnostic Accuracy of Returning to the Case to Reflect Upon the Initial Diagnosis.

Diagnostic errors have been attributed to failure to sufficiently reflect on initial diagnoses. However, evidence of the benefits of reflection is conflicting. This study examined whether reflection upon initial diagnoses on difficult cases improved diagnostic accuracy and whether reflection triggered by confrontation with case evidence was more beneficial than simply revising initial diagnoses. Participants were physicians in Bern, Switzerland, registered for the 2018 Swiss internal medicine certification exam. They diagnosed written clinical cases, providing an initial diagnosis by following the same instructions and returning to the case to provide a final diagnosis. The latter required different types of reflection depending on the physician's experimental condition: return without instructions, identify confirmatory evidence, identify contradictory evidence, or identify both confirmatory and contradictory evidence. The authors examined diagnostic accuracy scores (range 0-1) as a function of diagnostic phase and reflection type. One hundred and sixty-seven physicians participated. Diagnostic accuracy scores did not significantly differ between the 4 groups of physicians in the initial (I) or the final (F) diagnostic phase (mean [95% CI]: return without instructions, I: 0.21 [0.17, 0.26], F: 0.23 [0.18, 0.28]; confirmatory evidence, I: 0.24 [0.19, 0.29], F: 0.31 [0.25, 0.37]; contradictory evidence, I: 0.22 [0.17, 0.26], F: 0.26 [0.22, 0.30]; confirmatory and contradictory evidence, I: 0.19 [0.15, 0.23], F: 0.25 [0.20, 0.31]). Regardless of type of reflection employed while revising the case, accuracy increased significantly between initial and final diagnosis, I: 0.22 (0.19, 0.24) vs F: 0.26 (0.24, 0.29); P < .001. Physicians' diagnostic accuracy improved after reflecting upon initial diagnoses provided for difficult cases, independently of the evidence searched for while reflecting. The findings support the importance attributed to reflection in clinical teaching. Future research should investigate whether revising the case can become more beneficial by triggering additional reflection.

Adding to the debate on the numbers of options for MCQs: the case for not being limited to MCQs with three, four or five options

BackgroundThere is a significant body of literature that indicates that the number of options for single-best answer multiple choice questions (MCQs) can be reduced from five to three or four without adversely affecting the quality of the questions and tests. Three or four options equates to two or three distractors respectively.MaintextWhilst these arguments may be true when focusing on psychometric aspects of questions, we should also focus on educational and clinical authenticity aspects of questions. I present reasons for MCQs in tests to have a variable number of options which will usually be more than three, four, or five. These include: decisions related to broad clinical scenarios cannot be limited to a small number of options; options lists should include all possible combinations of option elements; and options that are rarely chosen can provide information regarding students and/or for students.ConclusionFinally, given computer based delivery, longer option lists are not impractical for examinees. In the contexts that are appropriate, it is time to consider a move to adopting appropriate and variable numbers of MCQ options and not be limited to MCQs with three, four or five options.

Evaluating the Quality of Multiple Choice Question in Paediatric Dentistry Postgraduate Examinations.

ObjectivesThis study aimed to evaluate the quality of multiple choice question (MCQ) items in two postgraduate paediatric dentistry (PD) examinations by determining item writing flaws (IWFs), difficulty index (DI) and cognitive level.MethodsThis study was conducted at Mohamed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE. Virtual platform-based summative versions of the general paediatric medicine (GPM) and prevention of oral diseases (POD) examinations administered during the second semester of the 2017–2018 academic year were used. Two PD faculty members independently reviewed each question to assess IWFs, DI and cognitive level.ResultsA total of 185 single best answer MCQs with 4–5 options were analysed. Most of the questions (81%) required information recall, with the remainder (19%) requiring higher levels of thinking and data explanation. The most common errors among IWFs were the use of “except” or “not” in the lead-in, tricky or unfocussed stems and opportunities for students to use convergence strategies. There were more IWFs in the GPM than the POD examination, but this was not statistically significant (P = 0.105). The MCQs in the GPM and POD examination were considered easy since the mean DIs (89.1% ± 8.9% and 76.5% ± 7.9%, respectively) were more than 70%.ConclusionTraining is an essential element of adequate MCQ writing. A general comprehensive review of all programme’s MCQs is needed to emphasise the importance of avoiding IWFs. A faculty development programme is recommended to improve question-writing skills in order to align examinations with programme learning outcomes and enhance the ability to measure student competency through questions requiring higher level thinking.

Breast self-examination among nurses in Poland and their reparation in this regard.

Working at night and in shifts, as well as an unhealthy lifestyle, may increase the risk of breast cancer in nurses who therefore should frequently perform breast self-examination (BSE). The aim of the study was to investigate the performance of BSE among Polish nurses, its accuracy, sources of knowledge and skills, self-assessment of own competences and preparation to educate women about BSE. A descriptive, cross-sectional study was conducted in a group of female nurses (N=1,242). An anonymous, self-administrated questionnaire was used for data collection. To properly assess the BSE a four-item scale was made of the type single best answer multiple choice question. Each item referred to one agreed principle of performing BSE. Regularly BSE was performed by 56.1% nurses, 67.3% pre-menopause nurses 2-3 days after cessation of menstruation and 30.4% post-menopause women on a chosen day of the month. About 98% examined visually and by palpation; 58.9% did so in two positions. In the accuracy scale of BSE, the average number of points was 2.8 out of 4. All (4 points) or almost all (3 points) recommendations of accurate BSE were met by 61.4% of the nurses. Self-assessment of knowledge and BSE practical skills were considered as good or very good by 93.5% and 88.8% nurses, respectively. The self-evaluation of nurses' knowledge and BSE skills was significantly correlated with the result on the accuracy scale or this BSE. Many deficiencies concerning frequency, times and BSE techniques were revealed among Polish nurses. There is a discrepancy between the high self-assessment of competences and the accurate practice of BSE. Nurses' preparation in Poland in BSE is insufficient and requires improvement.

Quantitative analysis of single best answer multiple choice questions in pharmaceutics

IntroductionThe purpose of this study was to: (1) analyze the quality of single best answer multiple choice questions (MCQs) used in pharmaceutics exams, (2) identify the correlation between difficulty index (DIF I), discriminating index (DI), and distractor efficiency (DE), and (3) understand the relationship between DIF I, DI, and DE and the number of MCQ answer options and their cognitive level. Methods429 MCQs used in pharmaceutics exams were analyzed. The quality of the MCQs was evaluated using DIF I, DI, and DE. The number of answer options and the cognitive level tested by each item were evaluated. Relationships between DIF I, DI, and DE were measured using Pearson's correlations and t-tests. ResultsDIF I showed a significant negative correlation with DI within questions that measured information recall. A significant negative correlation between DIF I and DI was observed in questions with four and five answer options regardless of the cognitive level measured. The highest DI values were found in moderate difficulty questions, while the worst DE was observed for the easiest questions. Questions that measured analytical and problem-solving abilities were more difficult than those measuring information recall. Questions with four and five answer options had excellent discrimination. ConclusionsSingle best answer MCQs are a valuable assessment tool capable of evaluating higher cognitive skills. Significant correlation between DIF I and DI can indicate the examination quality. Higher quality MCQs are constructed using four and five answer options.

Evaluation of a national neurosurgical formative examination: the UK experience

Introduction: Formative assessment is a key component in medical education and that it is a helpful process for all involved. Until recently there was no national formative examination for neurosurgical trainees. The Neurosurgery Annual in Training Examination (NAiTE) is an annual online, formative assessment that was introduced in 2014. In this paper, we seek to discuss how well NAiTE relates to established educational practice and principles and its fitness for purpose by discussing its rationale, structure and utility.Methods: A national online examination was introduced in 2014. The NAiTE consists of 100 single best answer multiple choice questions. The examination and questions with were reviewed and the global results presented. The existing literature and educational theory are used to guide subjective assessment of the process.Results: In 2016, 191 candidates participated in the NAiTE, of whom 154 were trainees working in UK neurosurgical units. The mean score for early stage UK trainees (years 1-3) was 52.4%, intermediate (years 4-5) 58.5% and senior (years 6-8) 65.4%. The NAiTE was found to be a reliable (Cronbach-Alpha of 0.89) and valid assessment of trainees with scores approximating those attained in the Intercollegiate Specialty Examination itself.Discussion: Potential areas for improvement are highlighted, including reference to some that have already been implemented.Conclusion: Overall, the examination is a cheap, viable and reliable means of testing trainees and encouraging their onward development and learning as they work towards the Intercollegiate Specialty Examination

Use of Item Analysis to Improve the Quality of Single Best Answer Multiple Choice Question in Summative Assessment of Undergraduate Medical Students in Malaysia.

Background: Single best answer (SBA) as multiple-choice items are often advantageous to use for its reliability and validity. However, SBA requires good number of plausible distractors to achieve reliability. Apart from psychometric evaluation of assessment it is important to perform item analysis to improve quality of items by analysing difficulty index (DIF I), discrimination index (DI) and distractor efficiency (DE) based on number of non-functional distractors (NFD). Objective: To evaluate quality of SBA items administered in professional examination to apply corrective measures determined by DIF I, DI and DE using students’ assessment score. Method: An evaluation of post summative assessment (professional examination) of SBA items as part of psychometric assessment is performed after 86 weeks of teaching in preclinical phase of MD program. 40 SBA items and 160 distractors inclusive of key were assessed using item analysis. 136 students’ score of SBA was analysed for mean and standard deviation, DIF I, DI and DE using MS Excel 2007. Unpaired t -test was applied to determine DE in relation to DIF I and DI with level of significance. Item-total correlation (r) and internal consistency by Cronbach’s alpha and parallel-form method was also computed. Result: 15 items had DIF I=.31-.61 and 25 items had DIF I ≤.30 or ≥0.61). 26 items had DI = 0.15 - ≥.25 compared to 14 items with DI (≤0.15). There were 26 (65%) items with 1-3 NFD and 14 (35%) items without any NFD. 39 (32.50%) distractors were with choice frequency=0. Overall mean DE was 65.8% and NFD was 49 (40.5%). DE in relation to DIF I and DI were statistically significant with p = .010 and .020 respectively. Item-total correlation for most items was <.3. Internal consistency by Cronbach’s alpha in SBA test 1 and 2 was .51 and .41 respectively and constancy by parallel-form method was .57 between SBA test 1 and 2. Conclusion: The high frequency of difficult or easy items and moderate to poor discrimination suggest the need of items corrective measure. Increased number of NFD and low DE in this study indicates difficulty of teaching faculty in developing plausible distractors for SBA questions. This has been reflected in poor reliability established by alpha. Item analysis result emphasizes the need of evaluation to provide feedback and to improve quality of SBA items in assessment.

Use of Item Analysis to Improve the Quality of Single Best Answer Multiple Choice Question in Summative Assessment of Undergraduate Medical Students in Malaysia

Use of Item Analysis to Improve the Quality of Single Best Answer Multiple Choice Question in Summative Assessment of Undergraduate Medical Students in Malaysia

Evaluation of multiple choice questions using item analysis tool: a study from a medical institute of Ahmedabad, Gujarat

Background: Multiple choice question (MCQ) assessments are becoming popular means to assess knowledge for many screening examinations among several fields including Medicine. The single best answer MCQs may also test higher-order thinking skills. Hence, MCQs remain useful assessment gadget. Objectives: 1) To evaluate Multiple Choice Questions for testing their quality. 2) To explore the association between difficulty index (p-value) and discrimination indices (DI) with distractor efficiency (DE). 3) To study the occurrence of functioning distractors for MCQs. Methods: Total five MCQ test sessions were conducted among interns of a medical institute of Ahmedabad city Gujarat, between April 2016 to March 2017, as part of their compulsory rotating postings in the department. The average participation in each of the sessions was 17 interns, thus a total of 85 interns getting enrolled. For each test session, the questionnaire consisted of forty MCQs having 4 options including a single best answer. The MCQs were analyzed for difficulty index (DIF-I, p-value), discrimination index (DI), and distractor efficiency (DE). Results: Total 85 interns attended the tests consisting of total 200 MCQ items (questions) from four major medical disciplines namely - Medicine, Surgery, Obstetrics &amp; Gynecology and Community Medicine. Mean test scores of each test ranged from 36.0% to 45.8%.The reliability of the tests, the Kuder Richardson (KR) 20, ranged from 0.29 to 0.52. The standard error of Measurement ranged from 2.59 to 2.79.Out of total 200 MCQs, seventy nine (n=79) had Discrimination index (DI) &lt;0.15 (poor), and 61 had DI ≥0.35 (excellent). Easy items having average DE of all tests was 20.1%. Conclusions: Items having average difficulty and high discrimination with functioning distractors should be incorporated into tests to improve the validity of the assessment.

Effectiveness of “fill in the blanks” over multiple choice questions in assessing final year dental undergraduates

Abstract Background Possibility of guessing in Multiple Choice questions (MCQ) when assessing undergraduates is considered a weakness. There are limited studies on the use of “Fill in the Blanks” (FIB) to overcome this issue. Objective To assess the effectiveness of FIB in MCQ for assessing final year dental undergraduates. Methods and materials A total of 134 final year dental undergraduates were randomly assigned to Group A and B. Group A was given a questionnaire with fifteen single best answer MCQ questions, and then the FIB questionnaire (which included the same questions in FIB form). At the same time Group B was given the FIB questionnaire initially, and then the MCQ questionnaire in the given period of time. The mean scores of the two groups were then compared. Results Group A obtained a mean score of 10.94 (SD ± 3.203) for MCQ, and 10.48 (SD ± 2.993) for FIB, whereas Group B obtained a mean score of 6.8 (SD ± 2.949) for FIB and 10.05 (SD ± 2.619) for MCQ. There was a statistically significant difference in the mean scores obtained for the two types of tests between Group A (P = .04) and Group B (P = .0001). The difference in the mean scores obtained for the FIB were statistically significant (P = .0001) between the groups, whereas the results were not statistically significant for MCQ (P = .127). Conclusion MCQ results revealed that the knowledge of the two groups was similar. The differences in the scores obtained for the two types of assessment tools suggest further research is needed to investigate the factors that led to the above observation.

Comparison of the problem based learning-driven with the traditional didactic-lecture-based curricula

ObjectivesTo compare the Problem-based learning (PBL) with the traditional lecture-based curricula. MethodsThe single best answer Multiple Choice Questions (MCQ) and the Objective Structured Clinical Examination (OSCE) were used to compare performance of the lecture-based curriculum with the PBL medical student groups. The reliability for the MCQs and OSCE was calculated with Kuder-Richardson formula and Cronbach’s alpha, respectively. The content validity of the MCQs and OSCE were tested by the Independent Subject Experts (ISE). The Student’s t-test for independent samples was used to compare the item difficulty of the MCQs and OSCE’s, and the Chi-square test was used to compare the grades between the two student groups. ResultsThe PBL students outperformed the old curriculum students in overall grades, theoretical knowledge base (tested with K2 type MCQs) and OSCE. The number of the PBL students with scores between 80-90% (grade B) was significantly (p=0.035) higher while their number with scores between 60 to 69% (grade C) was significantly p=0.001) lower than the old curriculum students. Similarly, the mean MCQ and the OSCE scores of the new curriculum students were significantly higher (p = 0.001 and p = 0.025, respectively) than the old curriculum students. Lastly, the old curriculum students found the K2-MCQs to be more (p = 0.001) difficult than the single correct answer (K1 type) MCQs while no such difference was found by the new curriculum students. ConclusionsSuitably designed MCQs can be used to tap the higher cognitive knowledge base acquired in the PBL setting.

Steps towards Updating the Curriculum and Teaching Methods in Obstetrics, Gynaecology and Neonatology in Mongolia

Background: Medical education in Mongolia faces many challenges in terms of staff capacity, large student numbers, and limited access to clinical experience. The Government of Mongolia has placed a high priority on reducing maternal and infant mortality, necessitating improvements to the quality of medical training, ensuring a highly skilled health workforce is produced and maintained. In 2014, a team of academic staff from Sydney Medical School were appointed by United Nations Population Fund (UNFPA) to assist in reviewing and updating the medical student curriculum in obstetrics, gynaecology and neonatology in accordance with international best practice. The first phase involved a visit from a senior delegation from Mongolia, including representatives from the Mongolian National University of Medical Sciences (MNUMS), UNFPA and the Mongolian Ministry of Health to Sydney. The week long programme was designed to demonstrate best practice in obstetrics, gynaecology and neonatology undergraduate medical education; and display modern teaching practices. Methods: Course design included demonstration and participation in a four station Structured, Clinical, Objective, Reference, problem-oriented, Integrated, and Organised (SCORPIO); observation of a Clinical Reasoning Session (CRS); demonstration and participation in a four station OSCE, and teaching of best practice in writing single-best answer multiple choice questions. Participants also took part in a teacher training session. The programme was implemented at a large teaching hospital in Sydney, Australia. We employed mixed-methods to evaluate the programme, using pre- and post-questionnaires and a focus group. Results: The programme increased participants’ perceived understanding and ability to apply educational principles, plan learning activities, and provide feedback. In particular, participants perceived that their understanding how to implement SCORPIO, CRS and OSCE had increased. However, participants would have liked greater opportunity to observe bedside teaching. Participants foresaw challenges to the implementation of educational changes in Mongolia, including the anticipated difficulty of engaging hospital staff in teaching; implementing a student-centred approach to teaching; and providing a large number of students with adequate clinical experience. Conclusion: Changes in educational strategy in Mongolia may assist medical schools to produce clinically competent graduates. Our programme provided an effective means to introduce Mongolian leaders in health and education to modern student-centred medical education teaching and assessment methods; and to highlight the importance of teacher training and evaluation as a strategy to engage both university and hospital staff in medical education. Additionally, programme outcomes assisted in subsequent phases of the project, including in-country needs assessment, curriculum development and delivery.

Flawed multiple-choice questions put on the scale: What is their impact on students′ achievement in a final undergraduate surgical examination?

Background : Violation of item-writing guidelines is still frequently encountered in assessments in medical colleges. Flawed multiple-choice (MC) items affect students' performance and distort examinations' results. Aims: The aim was to assess the frequency and impact of flawed MC items on students' achievement in our setting. Settings and Design: This is a quantitative descriptive study conducted at the Faculty of Medicine in the University of Tabuk, Saudi Arabia. Methods: We evaluated a 100 single-correct answer MC questions summative surgical examination administered to 44 6 th year final medical students in November 2014. MC items, which contain one or more violation of item-writing guidelines, were classified as flawed, those with no violation, were classified as standard. The passing rates and median scores of high- and low-achieving students were calculated on both standard and flawed test scales. Item performance parameters (difficulty index, discrimination power and internal consistency reliability (Kuder-Richardson formula 20) were calculated for standard and flawed items. Descriptive and comparative statistics with the relevant tests of significance were performed using the SPSS (IBM SPSS Inc. Chicago, Illinois) computer software version 16. Results: Thirty-nine flawed items were identified (39%) which contain 49 violations of the item-writing guidelines. The passing rate was 93.2% and 91.8% on the total and standard scales, respectively. Flawed items benefited low-achieving students and disadvantaged the high-achieving students. Overall, flawed items were less difficult, less discriminating and less reliable than standard items. Conclusions: The frequency of flawed items in our examination was high and reflects the need for more training and faculty development programmes.