High-level Skills Research Articles

Integration of Local Potential of Way Kambas National Park in Developing HOTS-Based Assessment Content in Biological Conservation Courses

The assessment of Higher Order Thinking Skills (HOTS) based on local potential has not been widely used in biological conservation education. Assessments like this aim to encourage students to think critically, analytically, and creatively, as well as familiarize students with solving problems in real contexts, especially in the conservation area of Way Kambas National Park (WKNP) in Lampung. This study aims to identify the local potential of WKNP conservation areas that have the potential to be integrated with the development of HOTS-based assessments in the Biological Conservation Course. The method used in this study is descriptive with a qualitative approach. Interviews were conducted with 6 informants. Triangulation techniques and data interpretation then analyzed the data obtained. The results of this study show that there is a lot of local potential in WKNP conservation area that has the potential to be integrated into the assessment content on 7 biological conservation materials that can be made HOTS-based assessments to hone students' high-level thinking skills.

Narrative production and executive functions in post-stroke agrammatic aphasia

ABSTRACT Background Narrative production has been widely characterized as providing an ecologically valid way to assess language skills in post-stroke aphasia. Although narrative tasks have been instrumental in delineating patterns of lexical and syntactic production in individuals with agrammatic aphasia, our knowledge of how narrative skills are affected in agrammatic aphasia is still limited. Aims The study’s aims were to (a) compare narrative performance between individuals with agrammatic aphasia and a language-unimpaired group, (b) investigate the contribution of lexical and syntactic skills in each group’s narrative organizational skills, and (c) explore the effects of executive functions on each group’s narrative performance. Methods & Procedures The study included 14 individuals with agrammatic aphasia and 14 age- and education-matched language unimpaired individuals as the control group. Both groups told the Cinderella story, and their narrative production was analyzed in terms of microstructure (lexical diversity, syntactic complexity, clause length) and macrostructure (story grammar, story structure complexity). Each group’s executive functions were evaluated through the One-Touch Stockings of Cambridge test that assesses working memory, and the Intra-Extra Dimensional Set Shift test that assesses cognitive flexibility. Outcomes & Results Regarding narrative microstructure, the individuals with agrammatism scored significantly lower than controls in syntactic complexity and clause length, but not in lexical diversity, but they performed lower than controls in both narrative macrostructural measurements. Also, the agrammatic group scored lower than controls in both executive function tasks. A series of linear regression models showed that microstructural skills significantly affected narrative macrostructural abilities in the cohort with agrammatic aphasia, while controls’ macrostructure was affected by both narrative microstructure and executive function skills. Conclusions The individuals with agrammatic aphasia exhibited impairment in both low-level language features of narrative production, such as syntactic complexity and narrative length, and global measures of narrative organization. Their macrostructural performance critically relied on their language resources, while controls’ narrative macrostructure seemed to also draw on domain-general cognitive skills. These findings suggest that both low-level language and high-level discourse organizational skills are vulnerable in narrative production in agrammatic aphasia, and that macrostructural skills are mainly related to the individuals’ microstructural skills.

Preparing future psychologists to develop motivational systems

This study aimed to investigate the process of developing motivational systems in aesthetic medicine, as undertaken by future psychology graduates. The methodology involved a combination of modelling and experimentation methods in medical clinics, where the effectiveness of motivational systems created by trainees was tested and evaluated. The research combined theoretical knowledge with practical application, enabling a detailed analysis of how motivational systems can be effectively designed and implemented by future specialists in psychology. The key findings demonstrated that practical involvement in real-world settings, such as medical clinics, significantly enhances trainees’ understanding and ability to develop effective motivational systems. The study revealed that integrating practical experience with a professional environment provides valuable insights that a purely theoretical approach cannot offer. The study confirmed that real-world experience in medical clinics helps future psychologists better understand the specific needs and challenges involved in developing motivational systems. Practical training in such settings allows theoretical knowledge to be adapted to real-life situations, significantly improving the effectiveness of the motivational systems created. Future psychologists who had the opportunity to work in clinics demonstrated a high level of skill in addressing practical tasks related to staff motivation, highlighting the substantial contribution of hands-on experience to their training. The research emphasised the importance of integrating practical experience with theoretical instruction in the education of future psychologists, particularly in the context of developing and implementing motivational systems. Educators can utilise the findings to enhance training programmes and approaches to preparing future specialists, especially in the development of specialised courses and training in motivational counselling

Towards implementing telemedicine in Tunisia: A knowledge, attitude and practice study among medical doctors.

Background: The use of information and communication technology such as telemedicine occupies nowadays a huge place in modern medicine practice all over the world, mainly after the COVID-19 pandemic. However, its implementation in Tunisia and other developing countries has achieved little success with low utilization and can be challenging for several reasons. In this study, our aim was to assess the knowledge, attitudes and practice of Tunisian medical doctors regarding telemedicine. Methods: This was a cross-sectional web survey, administered to medical doctors in Tunisia in October 2022. Respondents' level of knowledge of telemedicine was assessed by calculating a knowledge score (0 to 12). Attitude subsections were about perceived telemedicine attributes of relative advantage, compatibility, trial ability and complexity. Results: A total of 243 participants were included. The mean age was 45 ± 9.6 years old, and 57.2% were female, with a mean of 14.3 ± 10.3 years of professional experience. The majority (95.9%) had an average or high level of computer skills. More than half (59.3%) had a poor level of telemedicine knowledge. A good level of knowledge was significantly associated with age category over 50 years (p = 0.02) and with years of experience over 10 (p = 0.03). The majority (89.3%) had a moderate or high score about perceived advantages. The majority (88.5%) accepted use of telemedicine in their future practice. Almost half (46.9%) had practiced telemedicine activities before using a mobile phone (91%) or social media (64%). The principal limitations of applying telemedicine were challenges of organization and implementation, and incomplete patient examination. Conclusions: Although Tunisian doctors' knowledge and practice of telemedicine were unsatisfactory, their positive attitude and willingness to try it in their future practice were encouraging. There is an urgent need for implementing telemedicine in Tunisia to improve health care coverage in some unprivileged areas.

Support for Neurodivergent Students in Veterinary Education Part 1: Current Practice and Roundtable Discussion of Recommendations.

Approximately 10% of undergraduate student populations are neurodivergent. Such students have differences in executive functioning and social communication skills, which can confer both strengths and challenges in the academic environment. Specific challenges presenting in the veterinary curriculum include the intense workload, unpredictable nature of work, and high level of interpersonal and communication skills required in clinical settings. Extramural studies (EMS) occur remote from university support systems, adding further challenge for some students. A survey was sent to all current United Kingdom veterinary schools in 2022 to identify current support for neurodivergent students. An interactive roundtable discussion was held to brainstorm best practice for harnessing the power of neurodiversity in the clinical learning environment. Several consistent themes emerged. Most veterinary schools provide some degree of support for neurodivergent individuals, but support varies widely. Four of the 8 schools provide support at open days and/or following offers, with one school offering a summer school. Five schools confirmed that accommodations were made to clinical rotations and/or extramural studies in line with a support plan from their Disability Service. Despite these steps to assist neurodivergent students, support could, and should, be increased to improve the student experience. Suggested enhancements include a supportive environment for the empowerment of disclosure, neurodiversity awareness training for university staff and placement providers, provision of reasonable adjustment guidelines for EMS providers, clinical/intramural rotation orientation and support, and student access to a neurodiversity mentor/coach.

Outcome of primary fixation of traumatic acetabular fractures

Objectives; Traumatic acetabular fracture is a major injury with high association of mortality, morbidity and long recovery period. Surgical management of acetabular fracture is a technical challenge needing high level of skills and vigilance because of the complex anatomy and risk to surrounding structures. We aim to look at two surgical techniques for fixation of acetabular fracture and their outcome in this study. Methods; Between April 2018 and March 2023, a total of 26 patients (15 males and 11 females) were treated for acetabular fracture fixation. 10 were treated with minima invasive technique Close reduction and per-cutaneous fixation because of good reduction was achieved under image guidance and 16 patients had ORIF with use of various recon plates, screws and wires. Results; All patients were followed up for 12 months. Among all patients, the clinical outcomes were recorded as excellent in 17 patients (17/26, 65%), good in 5 (5/26, 19%), fair in 2 (2/26, 7.7%), and poor in 2 (2/26. 7.7%), according to the modified Merle d’Aubigné-Postel score. The average modified Merle d’Aubigné-Postel score was 15 ± 2.0 points (range, 10–18 points). The radio-logical healing was assessed according to the Matta score [22] and were reported excellent in 15 patients (15/26, 57.6%), good in 7 (7/26, 26.8%), fair in 1 (1/26, 3.8%),and poor in 3 (3/26, 11.5%). Conclusion; our study shows comparable clinical outcome for acetabular fracture fixation using either ORIF or CRPF technique. Right patient choice and good knowledge of anatomy is of paramount importance.

Diving into research without wading through content: A skills-based cell biology course emphasizing the unknown.

In a typical undergraduate biology curriculum, students do not dive into research until they first wade through large amounts of content. Biology courses in the first few years of the college curriculum tend to be lecture-based and exam-based courses. As a result, science students are mainly exposed to content knowledge-not the skills scientists practice daily. While students may practice manual techniques in lab sections of lecture courses, the higher-level analytical research skills are reserved for the final semesters of college. To address this issue, we created an undergraduate cell biology course centered around practicing research skills, and fully accessible to students with no prerequisite content knowledge. In our course, students read primary literature (no textbooks) and were assessed by writing 12 analytical response papers and a full research proposal (no exams). Each student chose a topic for their semester-long project, conducted a literature review, and proposed future experiments-all in a stepwise fashion with plentiful feedback. The students' thorough comprehension of the primary literature, along with successful completion of the research proposals, shows that the course achieved its goals of building these skills-even in the nonbiology majors taking this pilot course. Pre- and post-survey results demonstrate that students gained feelings of confidence and preparedness for future research experiences. We envision a future model in which such a skills-based course replaces a more traditional cell biology course, giving students the opportunity to practice high-level analytical research skills from very early on in the undergraduate biology curriculum.

Implementasi HOTS Pada Pembelajaran PAI melalui Kegiatan P5 dalam Meningkatkan Kemampuan Problem Solving Siswa

This research aims to identify the implementation of HOTS in increasing the understanding and application of religious values ??through P5 activities in the school environment and its influence on students' problem solving abilities. The importance of developing high-level thinking skills in learning and assessment in the field of Islamic religious education (PAI) because it has a central role in forming a deep understanding related to religious concepts. This research uses a qualitative approach with a case study method. Data collection using interviews, observation and documentation. Data analysis using Miels and Hubarman analysis techniques. Validity of research data with poleulation and increased research persistence. The research results are: first, the steps for implementing HOTS in PAI learning through P5 activities with structured planning and preparation, implementation, assessment and follow-up; second, the role of HOTS in PAI learning through P5 activities in improving students' problem solving abilities, namely: improving students' problem solving abilities, critical, analytical and creative thinking which are essential for solving complex problems, developing reflective and metacognitive attitudes; third, evaluation of the application of HOTS in PAI learning through P5 activities in improving students' problem solving abilities through observations, interviews and questionnaires which provide a comprehensive picture of the effectiveness of the approach.

Are interns prepared? A summary of current transition to residency preparation courses content.

The transition from medical student to emergency medicine resident is a critical point in training. Medical students start residency with different levels of understanding and some are not meeting the emergency medicine (EM) Level 1 milestones. Residency preparation courses (RPCs) were created to fill this gap and prepare medical students for residency. The objective was to review content from current RPC curricula to determine the content that should be included in an EM-specific transition to residency preparation course. We collected curricula from RPC course directors at different institutions and reviewed and coded the topics into categories: (1) didactics, (2) procedures, and (3) unique topics (defined as nontraditional topics that did not fit squarely into didactics or procedures). We obtained content from 13 different RPC curricula. Length of the courses ranged from one to 8 weeks with the mean being three weeks. Most courses were taught within a larger medical school course and were not specific to EM (62%). The most frequently taught didactic topics were airway interventions (85%), critical care (69%), and chest pain/shortness of breath (62%). Most programs included a simulation component (92%) and the most common procedures included airway interventions (69%); lines-central, arterial, and Cordis (69%); lumbar puncture (62%); and ultrasound (62%). Many of the courses had unique or special features taught within the curriculum. The most frequently taught unique content were sessions on self-awareness and self-regulation (85%) and advanced communication (69%). After multiple RPC curricula content was reviewed, a set of basic curriculum has been determined and supported by the content analysis. By including a standardized curriculum within RPC's, this will help better prepare medical students and create a standard for medical students entering EM residency and may allow intern orientations to focus on higher level skills.

Meta-Analysis Study: The Influence of Project Based Learning Models on Creativity and Science Learning Outcomes of Elementary School Students

The project based learning (PjBL) model is expected to be able to change students' learning styles by increasing motivation in learning, creativity in work, generating creative ideas, and being able to think critically. The meta-analysis research aims to find out how big the effect of the PjBL model is on the creativity and science learning outcomes of elementary school students?; Does the implementation of the PjBL model affect the creativity and science learning outcomes of elementary school students? Collecting articles using the publish or perish application with the keywords PjBL model, creativity, and elementary science learning outcomes. The data obtained was analyzed by calculating the effect size of each journal. Analysis of the average effect size of 0.92 is in the large category. The PjBL model influences the creativity and learning outcomes of elementary school students with r RE = 0.925 in the high category. This shows that the PjBL model can increase student creativity and learning outcomes in elementary school science learning. The PjBL model can improve and develop creativity and high-level thinking skills based on the demands of the 4.0 era.

Lifelong Learning and Sub-Saharan Africa's Dream of Economic Emancipation

Sub-Saharan Africa having remained economically poor throughout its more than sixty years of independence, and relying on the finding that the acquisition of a high level of digital and entrepreneurship skills tends to create wealth for nations in modern times, this study investigates the extent to which sub-Saharan Africa's higher education institutions may leverage the facilitation of the learning of digital technologies and entrepreneurship for Africa's economic emancipation through lifelong learning. The work carried out at the level of eight (8) lifelong learning outfits of eight (8) premier universities drawn from the four (4) regions of sub-Saharan Africa is scrutinised through the administration of a six(6)-item questionnaire with a view to establishing whether or not Africa's higher education institutions are currently facilitating the learning of digital technologies and entrepreneurship through lifelong learning to a level that may promote Africa’s economic emancipation. The findings of the current study are that sub-Saharan Africa i). possesses very few higher education institutions in comparison to the global average, ii). is yet to prioritise lifelong learning both nationally and at the higher education level and iii). is incapable to produce the needed population of digital and entrepreneurship graduates that may propel its economic emancipation as a result of its current level of neglect of lifelong learning.

ANALISIS SWOT PENGGUNAAN CHAT GPT DALAM DUNIA PENDIDIKAN ISLAM

Chat GPT is an artificial intelligence tool that has sparked debate regarding its implications for the world of education. Researchers use a qualitative method with a SWOT analysis framework approach to describe the strengths and weaknesses of ChatGPT, as well as discuss its opportunities and threats to Islamic education. Its strengths include the use of advanced natural language models to generate reasonable answers, the ability to improve itself, and the provision of personal and real-time responses. Thus, ChatGPT can enhance access to information, facilitate personalized and complex learning, and reduce the teaching workload, making processes and tasks more efficient. Its weaknesses include a lack of deep understanding, difficulty in evaluating the quality of responses, the risk of bias and discrimination, and a lack of high-level thinking skills. The threats to education include a lack of contextual understanding, threatening academic integrity, promoting discrimination in education, democratizing plagiarism, and the decline of high-level cognitive skills.

Efficacy of robot arm-assisted endoscopic submucosal dissection in live porcine stomach (with video)

Endoscopic submucosal dissection (ESD) is technically challenging and requires a high level of skill. However, there is no effective method of exposing the submucosal plane during dissection. In this study, the efficacy of robot arm-assisted tissue traction for gastric ESD was evaluated using an in vivo porcine model. The stomach of each pig was divided into eight locations. In the conventional ESD (C-ESD) group, one ESD was performed at each location (N = 8). In the robot arm-assisted ESD (R-ESD) group, two ESDs were performed at each location (N = 16). The primary endpoint was the submucosal dissection speed (mm2/s). The robot arm could apply tissue traction in the desired direction and successfully expose the submucosal plane during submucosal dissection in all lesion locations. The submucosal dissection speed was significantly faster in the R-ESD group than in the C-ESD group (p = 0.005). The blind dissection rate was significantly lower in the R-ESD group (P = 0.000). The robotic arm-assisted traction in ESD enabled a significant improvement in submucosal dissection speed, blind dissection rate which suggests the potential for making ESD easier and enhancing procedural efficiency and safety.

Implementing ARVi media to enhance students high order cognitive skills

High-order cognitive skills (HOCS) are required to solve problems and make decisions. ARVi or augmented reality virus is a learning medium used to enhance HOCS. Aims of this research is to find out the effect of implementing ARVi media on enhancing high-level cognitive skills of students. The research is a quasi-experiment with a pretest-posttest control group design. The research was conducted in MAN 1 Kota Bogor class 10 using the Merdeka curriculum. The research instrument is a multiple-choice test that has been validated to measure high-level cognitive skills. The result of the t-test shows t-value (3.14) > t-table (1.98), indicating that there is a significant difference between the posttest scores of the control group and the experimental group. This means that the use of ARVi media has an effect on high-level cognitive skills. The improvement in high-level cognitive skills was continuous in C5 (evaluation) at 78%, C6 (creation) at 72%, and C4 (analysis) at 70%. These results are not independent of the support provided by the various content offered by ARVi media, such as augmented reality, literacy, and high-level questionnaires. Current education can benefit from technologies like ARVi media that help increase the high-level cognitive skills of students.

Influence of biceps-triceps ratio on golf swing performance.

This study examines how maintaining a straight leading arm affects the muscle strength balance between the biceps and triceps in golfers and its influence on golf performance. We recruited 20 male participants aged 18-45, including 10 golfers and 10 non-golfers. The participants' average age was 25.6±6.2 years, height 1.8±0.07 m, and weight 75.6±10.2 kg. We measured isometric and isokinetic muscle strength using the Primus RS Dynamometer (BTE Technologies, Hanover, MD, USA) and assessed golf swing performance with the Optishot 2 Golf Simulator (Optishot, Brighton, MI, USA). Golfers exhibited significantly greater triceps strength (P = 0.02) and a lower biceps-to-triceps strength ratio (P = 0.002) than non-golfers. Low-handicap golfers showed more centered and consistent ball impacts compared to mid-handicap golfers. There were no significant differences in swing path and face angles between low- and mid-handicap golfers. Muscle strength and the biceps-to-triceps strength ratio correlated with driving distance, as well as the frequencies of specific swing paths, face angles, and ball impact points, highlighting the complex interplay between muscle balance and swing performance. Greater triceps strength and a lower biceps-to-triceps strength ratio are key for maintaining a straight leading arm, especially in skilled golfers. While increased muscle strength tends to enhance driving distance, it does not necessarily improve accuracy. Consistent ball impact points may indicate higher skill levels. Future research should involve a larger, more diverse participant pool to validate these findings and further explore the complex nature of golf swing performance.

Cognitive Style (Risk-Taking – Caution) Among Graduate Students

The current research aims to identify the level of cognitive style (Risk-Taking – Caution) among graduate students, and the statistically significant differences in cognitive style (Risk-Taking – Caution) according to the variable (gender/male – female). Also, the statistically significant differences in cognitive style according to the variable (specialization/scientific – humanities). To achieve the research objectives, the researcher adopted the Al-Rawi (2022) scale, which consists of 23 items, with each item having two points for risk-taking and one point for caution. The researcher extracted the psychometric properties, including discrimination and validity (both logical and apparent validity), while reliability was obtained using the test-retest method and Cronbach's alpha coefficient. The researcher applied the tool to a randomly selected research sample consisting of 300 graduate students, with 150 male and 150 female students from various faculties and departments of Tikrit University. The statistical methods used in the research include Chi-square test, one-sample t-test, independent two-sample t-test, Pearson correlation coefficient, and Cronbach's alpha equation. The study revealed that graduate students exhibit a high level of psychological skills and cognitive style (Risk-Taking – Caution). Additionally, there are statistically significant differences in the cognitive style (Risk-Taking, Caution) scale according to the variables of gender and specialization.

The Anatomy of Leadership: From Aspirational to Dark Side Leadership Traits

Leadership is all about others on your team and in your organization. Surgical professionals are most likely to follow leaders they trust to care about their professional and personal well-being, and are aligned with their values, while setting and implementing organizational strategy. Ironically, in order to lead others well, it is best and most effective if leaders are humble, vulnerable, and willing to learn more about themselves: specifically their behavioral tendencies when they both are at their best and when they are under duress. For us as leaders, this includes understanding our own predominant leadership style(s); and learning how to expand our leadership preferred tendencies to other styles that may be more effective in certain situations. The POSNA leadership program (PLP) enables participants and faculty to study effective leadership principles and theories; evaluate published examples of exceptional and disastrous leadership in volatile, uncertain, complex, and ambiguous (VUCA) real life situations; and have in-depth dialogue on how pediatric orthopaedic surgery leaders can learn from and positively model exemplary leadership characteristics and behaviors. Although our operating rooms, clinics, research and administrative areas are not battlefields, and we are healers not warriors, we and the teams we lead do face uncertain, ambiguous, complex and even volatile situations often enough to require implementation of those refined, high-level skills. Key Concepts(1)Like all leaders, surgeons have preferred leadership styles. Learning about, expanding, and adapting leadership style(s) to specific situations is important and impactful.(2)The most effective leaders are humble, have high integrity, think strategically, are decisive decision makers after input from their trusted professional teams.(3)Trust is the essential ingredient of leading successful teams and organizations. Building trust requires empathy, high task competency, the ability to actively listen and engage in dialogue before and during implementation of plan(s).(4)Volatile, Uncertain, Complex, and Ambiguous (VUCA) dilemmas and challenges occur. Leaders and teams who can manage stress, mobilize necessary resources, and respond in a timely fashion to each VUCA situation are most effective.(5)Disruptive behaviors in our profession are more common than ideal. Responding to unprofessional acts, managing perceptions, and redirection to acceptable behavior lessens safety risk for patients and improves team performance and professional well-being.

The Effect of Total Body Resistance Exercise Variations on the Speed of Youth Pencak Silat Scythe Kicks

The magnitude of the sickle strike directly influences the number of match points that can be achieved in the martial art of Pencak Silat. The aim of this study is to undertake a comprehensive analysis of the impact of different types of Total Body Resistance Exercise training on the speed of Pencak silat sickle kicks performed by teenagers. This research methodology utilises a hypothetical inquiry that consists of two distinct groups: an experimental group and a control group. The subjects of this study were combatants who had engaged in the practice of Pencak silat at State Vocational High School (SMK) Negeri 1 Stabat. There were a total of 52 participants who met the requirements for this inquiry. The sample was gathered using purposive sampling, which followed the specified criteria. To participate, one must have attended Pencak silat training sessions at SMK N 1 Stabat, have a high level of skill in the fundamental methods of the sickle kick, be between the ages of 17 and 19, and be willing to serve as a study sample. The confirmation of eligibility for a group of 33 individuals, consisting of 17 girls and 16 males, resulted from the assessment of these specific criteria. This research apparatus is utilised to assess the speed of Pencak silat kicks and estimate the impact of sickle blows. Consequently, Total Body Resistance Exercise training affects the speed of sickle kicks. However, there is no noticeable statistically significant variation in sickle kick speed among adolescent Pencak Silat practitioners.

Analysis of Multiple Choice HOTS Test Questions on the Final Semester Assessment

Assessment is essential in the education system to monitor educational development and make appropriate instructional decisions. This study aims to analyze the quality of multiple choice questions based on high-level thinking skills (HOTS) in the Geography subject using Anates Windows Version 4.0.9 software. This evaluative research involves analysis of final semester exam questions for class X Geography at SMA Islam Al Azhar 14 Semarang. Data consisting of questions, answer keys and exam results were collected from 32 students. The analysis was carried out descriptively and quantitatively to assess the level of difficulty, discriminating power, reliability, effectiveness of distractors, and validity of the questions. The analysis results show that the difficulty level of most of the questions is in the medium category (50%). The discriminating power is mostly good, although several questions are wrong or bad. Most of the distractors worked well, but some questions had ineffective distractors. Regarding validity, 17 questions were valid, while 11 questions were invalid. The reliability of the test is in the high category, with a reliability coefficient of 0.71. Anates Windows Version 4.0.9 software effectively analysed the quality of HOTS questions. These findings indicate that although most of the questions are of good quality, some require revision to increase their validity and effectiveness. This research emphasizes the importance of using technology in educational assessment to ensure the quality and fairness of exam questions. It contributes to developing assessment tools to improve students' higher-order thinking skills.Keywords: Item Analysis; Multiple Choice; HOTS; SMA Islam Al-Azhar

Evaluating the Quality of Examination Items From the Pathophysiology, Drug Action, and Therapeutics Course Series

ObjectiveTo determine the impact of item-writing flaws and cognitive level on student performance metrics in 1 course series across 2 semesters at a single institution. MethodsFour investigators reviewed 928 multiple-choice items from an integrated therapeutics course series. Differences in performance metrics were examined between flawed and standard items, flawed stems and flawed answer choices, and cognitive levels. ResultsReviewers found that 80% of the items were flawed, with the most common types being implausible distractors and unfocused stems. Flawed items were generally easier than standard ones, but the type of flaw significantly impacted the difficulty. Items with flawed stems had the same difficulty as standard items; however, those with flawed answer choices were significantly easier. Most items tested lower-level skills and have more flaws than higher-level items. There was no significant difference in difficulty between lower- and higher-level cognitive items, and higher-level items were more likely to have answer flaws than item flaws. ConclusionItem-writing flaws differently impact student performance. Implausible distractors artificially lower the difficulty of questions, even those designed to assess higher-level skills. This effect contributes to a lack of significant difference in difficulty between higher- and lower-level items. Unfocused stems, on the other hand, likely increase confusion and hinder performance, regardless of the question’s cognitive complexity.