Multiple-choice Exam Questions Research Articles

Local Fourier features for handwriting digit images classification

Multiple choice questions (MCQ) are effective in normative assessment and offline testing is still relevant due to the lack of efficient mass infrastructures and maintenance. For the automatic correction of MCQ paper form and reporting of the grade, it is generally necessary to read and recognize a handwriting digit in a box. This paper focuses on local feature extraction in the frequency domain using Fourier transform. The pre-process begins with the extraction of the fields from the entity map, followed by the application of 2D fast Fourier transform (2DFFT) and the reduction of computed coefficients to obtain the corresponding final local characteristic in the representation. The experimental results of the Modified National Institute of Standards and Technology (MNIST) handwriting digits dataset show that the local characteristics extracted in the frequency domain used as input to a support vector machine (SVM) classifier are efficient in terms of 99.51% accuracy. The proposed system successfully helped in the reporting of all the marks for seven subjects in a class of 98 students during the automatic correction of the MCQ exam papers.

The impact of systematically repairing multiple choice questions with low discrimination on assessment reliability: an interrupted time series analysis

At our centre, we introduced a continuous quality improvement (CQI) initiative during academic year 2018-19 targeting for repair multiple choice question (MCQ) items with discrimination index (D) < 0.1. The purpose of this study was to assess the impact of this initiative on reliability/internal consistency of our assessments. Our participants were medical students during academic years 2015-16 to 2020-21 and our data were summative MCQ assessments during this time. Since the goal was to systematically review and improve summative assessments in our undergraduate program on an ongoing basis, we used interrupted time series analysis to assess the impact on reliability. Between 2015-16 and 2017-18 there was a significant negative trend in the mean alpha coefficient for MCQ exams (regression coefficient -0.027 [-0.008, -0.047], p = 0.024). In the academic year following the introduction of our initiative (2018-19) there was a significant increase in the mean alpha coefficient (regression coefficient 0.113 [0.063, 0.163], p = 0.010) which was then followed by a significant positive post-intervention trend (regression coefficient 0.056 [0.037, 0.075], p = 0.006). In conclusion, our CQI intervention resulted in an immediate and progressive improvement reliability of our MCQ assessments.

Postexamination item analysis of undergraduate pediatric multiple-choice questions exam: implications for developing a validated question Bank.

Item analysis (IA) is widely used to assess the quality of multiple-choice questions (MCQs). The objective of this study was to perform a comprehensive quantitative and qualitative item analysis of two types of MCQs: single best answer (SBA) and extended matching questions (EMQs) currently in use in the Final Pediatrics undergraduate exam. A descriptive cross-sectional study was conducted. We analyzed 42 SBA and 4 EMQ administered to 247 fifth-year medical students. The exam was held at the Pediatrics Department, Qena Faculty of Medicine, Egypt, in the 2020-2021 academic year. Quantitative item analysis included item difficulty (P), discrimination (D), distractor efficiency (DE), and test reliability. Qualitative item analysis included evaluation of the levels of cognitive skills and conformity of test items with item writing guidelines. The mean score was 55.04 ± 9.8 out of 81. Approximately 76.2% of SBA items assessed low cognitive skills, and 75% of EMQ items assessed higher-order cognitive skills. The proportions of items with an acceptable range of difficulty (0.3-0.7) on the SBA and EMQ were 23.80 and 16.67%, respectively. The proportions of SBA and EMQ with acceptable ranges of discrimination (> 0.2) were 83.3 and 75%, respectively. The reliability coefficient (KR20) of the test was 0.84. Our study will help medical teachers identify the quality of SBA and EMQ, which should be included to develop a validated question bank, as well as questions that need revision and remediation for subsequent use.

Assessing ChatGPT's Mastery of Bloom's Taxonomy Using Psychosomatic Medicine Exam Questions: Mixed-Methods Study.

Large language models such as GPT-4 (Generative Pre-trained Transformer 4) are being increasingly used in medicine and medical education. However, these models are prone to "hallucinations" (ie, outputs that seem convincing while being factually incorrect). It is currently unknown how these errors by large language models relate to the different cognitive levels defined in Bloom's taxonomy. This study aims to explore how GPT-4 performs in terms of Bloom's taxonomy using psychosomatic medicine exam questions. We used a large data set of psychosomatic medicine multiple-choice questions (N=307) with real-world results derived from medical school exams. GPT-4 answered the multiple-choice questions using 2 distinct prompt versions: detailed and short. The answers were analyzed using a quantitative approach and a qualitative approach. Focusing on incorrectly answered questions, we categorized reasoning errors according to the hierarchical framework of Bloom's taxonomy. GPT-4's performance in answering exam questions yielded a high success rate: 93% (284/307) for the detailed prompt and 91% (278/307) for the short prompt. Questions answered correctly by GPT-4 had a statistically significant higher difficulty than questions answered incorrectly (P=.002 for the detailed prompt and P<.001 for the short prompt). Independent of the prompt, GPT-4's lowest exam performance was 78.9% (15/19), thereby always surpassing the "pass" threshold. Our qualitative analysis of incorrect answers, based on Bloom's taxonomy, showed that errors were primarily in the "remember" (29/68) and "understand" (23/68) cognitive levels; specific issues arose in recalling details, understanding conceptual relationships, and adhering to standardized guidelines. GPT-4 demonstrated a remarkable success rate when confronted with psychosomatic medicine multiple-choice exam questions, aligning with previous findings. When evaluated through Bloom's taxonomy, our data revealed that GPT-4 occasionally ignored specific facts (remember), provided illogical reasoning (understand), or failed to apply concepts to a new situation (apply). These errors, which were confidently presented, could be attributed to inherent model biases and the tendency to generate outputs that maximize likelihood.

Quality Evaluation of Multiple-Choice Questions as an Assessment Tool for Medical Students

Background and Aims: Assessment is an educational process that measures student ability to accomplish specific objectives, helping to bridge the gap between teaching and learning. This study evaluated the quality of multiple-choice questions (MCQs) used to assess undergraduate medical students’ knowledge in the Nutrition &amp; Metabolism course at Taibah University. Methods: The study used item analysis to evaluate the MCQs, including item difficulty, item discrimination, reliability, standard error of measurement, and distractor analysis. The study enrolled 171 undergraduate medical students who took a 30-item MCQ exam. Results: The results showed that the exam was reliable and consistent in measuring students’ knowledge and understanding, but some items had issues that needed revision or deletion from the question bank. The report provides useful information for improving the exam’s quality and highlights the importance of ongoing assessment and revision of exam items. The findings suggest that ongoing assessment and revision of exam items are crucial to improving the quality of assessments and creating more effective measures of student learning. Conclusions: By leveraging these results, educators can identify areas where students may need further support and improve the design of their assessments.

Performance of ChatGPT and Bard on the official part 1 FRCOphth practice questions

BackgroundChat Generative Pre-trained Transformer (ChatGPT), a large language model by OpenAI, and Bard, Google’s artificial intelligence (AI) chatbot, have been evaluated in various contexts. This study aims to assess these...

Changing Answers in Multiple-Choice Exam Questions: Patterns of TOP-Tier Versus BOTTOM-Tier Students in Podiatric Medical School.

Students often express uncertainty regarding changing their answers on multiple choice tests despite multiple studies quantitatively showing the benefits of changing answers. Data was collected from 86 first-year podiatric medical students over one semester for the course of Biochemistry, as shown in electronic testing data collected via ExamSoft's® Snapshot Viewer. Quantitative analysis was performed comparing frequency of changing answers and whether students changed their answers from incorrect-to-correct, correct-to-incorrect, or incorrect-to-incorrect. A correlation analysis was performed to assess the relationship between the frequency of each type of answer change and class rank. Independent-sample t-tests were used to assess differences in the pattern of changing answers amongst the top and bottom performing students in the class. The correlation between total changes made from correct-to-incorrect per total answer changes and class rank yielded a positive correlation of r = 0.218 (P = .048). There was also a positive correlation of r = 0.502 (P < .000) observed in the number of incorrect-to-incorrect answer changes per total changes made compared to class rank. A negative correlation of r = -0.382 (P < .000) was observed when comparing class rank and the number of changed answers from incorrect-to-correct. While most of the class benefited from changing answers, a significant positive correlation of r = 0.467 (P < .000) for percent ultimately incorrect (regardless of number of changes) and class rank was observed. Analysis revealed that class rank correlated to likelihood of a positive gain from changing answers. Higher ranking students were more likely to gain points from changing their answer compared to lower ranking. Top students changed answers less frequently and changed answers to an ultimately correct answer more often, while bottom students changed answers from an incorrect answer to another incorrect answer more frequently than top students.

Assessment of multiple-choice questions by item analysis for medical students’ examinations

Background: Multiple-choice questions (MCQs) are a common assessment method, and it is crucial to design them carefully. Therefore, this study aimed to determine the item analysis of MCQ exams in clerkship tests for general medicine students. Methods: Following a cross-sectional study, a total of 1202 MCQs designed for fourth-year clerkship medical students in the second semester of 2019 were analyzed. Difficulty and discrimination indices of student scores and taxonomy levels were then computed. Furthermore, the prepared standard structural Millman checklist was utilized. Results: Of the 1202 MCQs, according to difficulty indices, most questions (666) were considered acceptable (55.39%). In terms of the discrimination index (DI), 530 (44.09%) questions had an average discrimination coefficient. Additionally, 215 (17.88%) had a negative or poor DI and required revision or elimination from the tests bank. Of the 1202 MCQs, 669 (50.7 %) were designed at a lower cognitive level (taxonomy I), 174 (14.5 %) belonged to taxonomy II, and 419 (34.8%) of the questions had taxonomy III. Moreover, according to the structural flaws of the Millman checklist, the most common structural flaw was a lack of negative choices for Stems 1127 (93.8 %), while vertical options 376 (31.3%) were the least common. Conclusion: Based on the results, it is recommended that easy questions and negative/poor DI of items, a high level of Bloom’s taxonomy type I, and questions with unstructured flaws be reviewed and reconstructed to improve the quality of the question banks. Holding training courses on designing test questions could effectively improve the quality of the questions.

Feedback, fairness, and validity: effects of disclosing and reusing multiple-choice questions in medical schools

ABSTRACT Background Disclosure of items used in multiple-choice-question (MCQ) exams may decrease student anxiety and improve transparency, feedback, and test-enhanced learning but potentially compromises the reliability and fairness of exams if items are eventually reused. Evidence regarding whether disclosure and reuse of test items change item psychometrics is scarce and inconclusive. Methods We retrospectively analysed difficulty and discrimination coefficients of 10,148 MCQ items used between fall 2017 and fall 2019 in a large European medical school in which items were disclosed from fall 2017 onwards. We categorised items as ‘new’; ‘reused, not disclosed’; or ‘reused, disclosed’. For reused items, we calculated the difference from their first ever use, that is, when they were new. Differences between categories and terms were analysed with one-way analyses of variance and independent-samples t tests. Results The proportion of reused, disclosed items grew from 0% to 48.4%; mean difficulty coefficients increased from 0.70 to 0.76; that is, items became easier, P < .001, ηp 2 = 0.011. On average, reused, disclosed items were significantly easier (M = 0.83) than reused, not disclosed items (M = 0.71) and entirely new items (M = 0.66), P < .001, ηp 2 = 0.087. Mean discrimination coefficients increased from 0.21 to 0.23; that is, item became slightly more discriminating, P = .002, ηp 2 = 0.002. Conclusions Disclosing test items provides the opportunity to enhance feedback and transparency in MCQ exams but potentially at the expense of decreased item reliability. Discrimination was positively affected. Our study may help weigh advantages and disadvantages of using previously disclosed items.

Assessment of multiple choice question exams quality using graphical methods

Exams should be valid, reliable, and discriminative. Multiple informative methods are used for exam analysis. Displaying analysis results numerically, however, may not be easily comprehended. Using graphical analysis tools could be better for the perception of analysis results. Two such methods were employed: standardized x-bar control charts with standard error of measurement as control limits and receiver operator characteristic curves. Exams of two medical classes were analyzed. For each exam, the mean, standard deviation, reliability, and standard error of measurement were calculated. The means were standardized and plotted against the reference lines of the control chart. The means were chosen as cut-off points to calculate sensitivity and specificity. The receiver operator characteristic curve was plotted and area under the curve determined. Standardized control charts allowed clear, simultaneous comparison of multiple exams. Calculating the control limits from the standard error of measurement created acceptable limits of variability in which the standard deviation and reliability were incorporated. The receiver operator characteristic curve graphically showed the discriminative power of the exam. Observations made with the graphical and classical methods were consistent. Using graphical methods to analyse exams could make their interpretation more accessible and the identification of exams that required further investigation easier.

Evaluating the impact of a flipped classroom model based on cognitive science of learning strategies in a pharmacotherapy course

IntroductionThe purpose of this study was to determine the impact of a flipped classroom method based on cognitive science of learning strategies on student performance and experience in a third-year pharmacotherapy course. MethodsThe cognitive science of learning flipped classroom (CSL-FC) strategies in this study included pre-class learning (Preview), in-class application to cases (Retrieval), after-class learning (Spaced Retrieval), and post-module reflection (Deliberate Reflection) in a required pharmacotherapy course. During fall 2017, one instructor piloted the CSL-FC method. During fall 2018, this method expanded to four instructors. All other instructors used traditional lecture-based methods. The same multiple-choice exam questions were used both years. The average exam question scores between teaching methods were compared by independent t-test. Student focus groups were conducted after the 2017 semester. In 2018, students were surveyed using a 5-point Likert rating (1 = strongly agree, 5 = strongly disagree) to evaluate their experience. ResultsThe 2017 and 2018 classes included 132 and 137 students, respectively. During the two years, exam question scores were significantly better with CSL-FC (n = 136 questions) compared to traditional (n = 110 questions) (88.8% vs 84.9%, respectively; P = .02). The focus group analysis revealed three main themes including a “love-hate relationship,” “time,” and “it works.” Student agreement to the survey question “the cognitive science of learning flipped classroom helped me learn” was 2.18 (SD 1.12). ConclusionsImplementing a flipped classroom approach based on cognitive science of learning strategies positively impacted student performance and experience in a pharmacotherapy course.

ASSESSMENT OF MULTIPLE CHOICE QUESTIONS TEST ITEM QUALITY AFTER POST EXAM ITEM ANALYSIS

Item analysis is the collection, summarization and utilizing information from students' responses to assess the quality of test items. The item statistics can distinguish between good items and those that need improvement or deletion from question bank. Our aim is to assess the quality of the summative Multiple Choice Questions (MCQs) for all courses of the M.B.B.Ch program before and after staff awareness campaign, College of Medicine, Taibah University, KSA, 2020. This study is a Quasi-experimental pre-post test study design and was conducted in 4 stages, collection of the MCQ exams, conduction of Awareness campaign on how to benet the post-exam item analysis, Re-collection and analysis of the post-exam item analysis and Finally, the results of the post exam item analysis of both academic years were compared to detect any changes in the items quality. showed that there were marked improvement of good quality items after awareness campaign especially in the Pre-clinicalResults courses than clinical ones IN Item analysis when regularly incorporated can help to develop a very useful, valid and a reliable questionConclusion bank by changing awed items either by rectied or deleted from the question bank

GARLAQs vs. Multiple Choice Questions: Do First‐Year Medical Students Perform Similarly on their Anatomy Examinations?

PURPOSEMedical students at the Case Western Reserve University School of Medicine are assessed on their knowledge of anatomy using an essay exam that tests clinically relevant anatomy/radiology concepts (Gross Anatomy, Radiology, and Living Anatomy Questions, or GARLAQ). GARLAQs are uniquely designed to facilitate student collaboration, as such these essay questions are given to students months prior to examination. This format has raised concerns about student memorization and a lack of in‐depth understanding of GARLAQ answers. The purpose of the present study is threefold: 1) to examine whether students perform similarly on GARLAQs and Multiple Choice Question (MCQ) examinations, 2) to assess whether students perform similarly to the GARLAQs on MCQs throughout the hierarchy of Bloom’s Taxonomy, 3) to collect qualitative data on student opinions of both assessment formats.METHODSFirst‐year medical students will be assessed during the gastrointestinal unit of their clinical anatomy curriculum. Volunteers will be recruited from a class of 184 students. A crossover study design will be employed, wherein participants will be randomly placed into one of two cohorts: 1) first complete the required GARLAQ exam, second the MCQ exam, or 2) first complete the MCQ exam, second the required GARLAQ exam. A paired t‐test will determine if there is a difference in overall examination performance for each respective student. Each MCQ will be categorized using Bloom’s Taxonomy. A paired t‐test will compare each student’s mean scores by Bloom’s category to their GARLAQ performance. Participants will also complete a post‐test survey in which they will be asked to rate their opinions about contrasting exam modalities on a 5‐point Likert scale.RESULTSData collection is currently ongoing and will be completed in February, 2022CONCLUSIONInformation gained through review of student assessment scores and responses can guide future curricular changes at our institution in a cycle of continuous improvement.

RANCANG BANGUN APLIKASI LEARNING MANAGEMENT SYSTEM DENGAN FRAMEWORK CODEIGNITER UNTUK MENINGKATKAN EFEKTIVITAS PEMBELAJARAN PADA SMK DARUL ISHLAH

The learning process in Darul Ishlah Vocational High School is not optimal, student learning outcomes have not reached optimal, monotonous learning media, limited learning time, and delays in the learning process if the teacher concerned is unable to attend are the main things behind the research. Darul Ishlah Vocational High School require an innovative learning media that can be used to implement learning both face-to-face and online. So that the learning that is carried out can run as it should and the rate of student learning can increase and be able to explore the material provided by teacher and be able to increase student interest and learning outcomes in accordance with the targets set by the school. Therefore, one of the efforts to increase the effectiveness of learning that can be done is to implement a Learning Management System by combining face-to-face and online learning which is an alternative to learning process at Darul Ishlah Vocational School both in pandemic conditions and face-to-face learning processes. The purpose of this study was to test the effectiveness of the LMS implementation on the student learning process. System development in making applications using the method Waterfall. The modeling system used is the Unified Modeling Language (UML). In making applocations using PHP with the Codeigniter Framework as language scripting and the framework used to create applications, MySQL as the database. With this LMS, it is hoped that it can help the learning process become more effective, make it easier for teacher to distribute materials, assignment, exam questions to student. This LMS application can be used as an additional discussion medium for teacher and student to discuss unfinished subject matter, and a student can work on multiple-choice exam questions and collect assignments given by the teacher.

THE NATIONAL LICENSING EXAMINATION: A COMPARISON WITH OTHER MAJOR MEDICAL LICENSING EXAMINATIONS AND PRACTICAL SUGGESTIONS FOR WIDER ACCEPTANCE

THE NATIONAL LICENSING EXAMINATION: A COMPARISON WITH OTHER MAJOR MEDICAL LICENSING EXAMINATIONS AND PRACTICAL SUGGESTIONS FOR WIDER ACCEPTANCE

Impact of Online Knowledge and Skills Learning on Millennial Learners Within Emergency Medicine: A Retrospective Data Review.

Background: Emergency Medicine didactic teaching has traditionally been delivered through face-to-face (F2F) lectures. However, during the pandemic of COVID-19, the didactic teaching was switched to online through using Microsoft Teams. The aim of this study was to assess the impact of online learning in the knowledge and skills acquisition of millennial learners based within emergency medicine.Methodology: This was a retrospective review of assessment data. Over a period of 10 months (August 2019 to June 2020), each resident was exposed to traditional F2F teaching for a period of four months and then online teaching in a crossover manner. After each method, there were two types of assessments, multiple-choice questions (MCQs) and computer-based objective structured clinical examination (OSCE). A total of 20 MCQs with one correct answer, totaling 20 marks, and 20 OSCEs consisting of an image or a video with five options, each option carrying one mark, totaling 100 marks were used at each assessment point. A student t-test was used to compare the two groups of results.Results: The total number of participants was 49 (n=49). All residents belonged to the millennial generation. Fourteen were female and 35 were male. The mean MCQ 1 score after F2F teaching was 12.16 (SD=1.688), whilst the mean MCQ 2 score after online teaching was 13.40 (SD=1.861). The mean computer-based OSCE 1 score after F2F teaching was 64.45 (SD=5.895), whilst the mean OSCE 2 score after online teaching was 65.57 (SD=5.969). Ten out of 49 students (20.4%) failed the MCQ exam after F2F teaching, whilst 6/49 students (12.2%) failed the MCQ test after online teaching. Seven out of 49 students (14.3%) failed the OSCE exam after F2F teaching, while six out of 49 students (12.2%) failed the OSCE exam after online teaching. There was a statistically significant improvement in the MCQ score after online teaching as compared to F2F teaching (P-value 0.0003), whilst there was no statistically significant change in the OSCE between the two-teaching methods (P-value 0.3513).Conclusion: Both F2F and online teaching methods resulted in a significant improvement in the knowledge and skills of emergency medicine residents. Online education resulted in a statistically significant improvement of MCQ score as compared to F2F teaching. The difference in MCQ score may be due to millennial learners, who traditionally benefit proportionately more from self-learning that is primarily online.

Distractor analysis of multiple choice questions: A descriptive study of physiology examinations at the Faculty of Medicine, University of Khartoum

Background: Distractor analysis is an important component of item analysis. It helps in the design and construction of items with functional effective distractors which are valid for future use and developmentof proper question banks.Objectives: This study aimed at investigating distractors’ functionality of physiology multiple choicequestion (MCQ) items at the Faculty of Medicine, Khartoum University using post- examination item analysis data.&#x0D; Methods: Analyzing test statistics reports produced by Remark-Software, the frequency distribution of non-functioning (NFD) or non-effective distractors (NED) on ten summative physiology MCQ exams administered to undergraduate medical students in the period from September 2015 to September 2016 was assessed. Item analysis reports provided detailed options analyses in the form of response frequency and discrimination power of each option. Each exam paper consisted of 60-80 (five-option) items and the number of the examinees ranged from 332 to 359. A total of 654 items were reviewed, including 2580 distractors. NFD/NED were defined as distractors with either response frequency&lt;5% of the examinees or non-negative discrimination coefficient (rpbis) criteria. Furthermore, the number of NFD/NED per item were computed to measure distractor efficiency (DE %) of an item as follows; 0 NED = 100 % DE, 1 NED = 75%DE, 2 NED = 50% DE, 3 NED = 25% DE, 4 NED = 0% DE.&#x0D; Results: Although less than one-third (31%) of total number of distractors were non-functioning because they were chosen by less than 5% of examinees, only 4 (0.15%) distractors had a choice frequency ofzero. In addition, 9.38% of total number of distractors was non-functioning because they had non-negative discrimination correlation coefficient. Defining functioning distractors using response frequency or discrimination ability criterion, the majority (61%) of our distractors were functioning effectively. The mean DE was 59.46±28.376% and the proportion of functional distractors ranged from 40.27% - 75% in the ten exams. Our study proportions of items with 100%, 75%, 50%, 25%, 0% DE were: 32.7%, 31.3%, 20.9%, 9.9% &amp; 5.1% respectively based on response frequency criterion alone, compared to: 8.2%, 12.3%, 28.7%, 35.2% &amp; 15.7% respectively when using any of the two criterion for NED definition.&#x0D; Conclusion: The findings that the majority of our distractors were functioning and the high proportions of our items that have high distractor efficiency are explained by the fact that our expert staff memberscarefully reviewed distractors to ensure unambiguity of the correct answers and generated plausible effective distractors.

Reliability of physiology MCQs’ examinations at the Faculty of Medicine, University of Khartoum

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The influence of dissection on clinical anatomical knowledge for surgical needs

PurposeDue to the ongoing discussion of the usefulness of dissection on human bodies in medical curricula, we investigated the influence of anatomical knowledge collected in the dissection course and requested for modules of visceral surgery.MethodsStudents attending the dissection course of topographic anatomy had to answer a questionnaire of 22 questions with focus on anatomical knowledge required for visceral surgical modules. Failure was defined as 13 or fewer correct answers, success categorized as high, good or moderate. The same questionnaire was handed out to 245 students prior to the module on visceral surgery. Students provided information on which regions they had dissected during the course or prior to the module. The results were compared to the result of a written Multiple Choice Question (MCQ) exam of the module visceral surgery (n = 160 students) with an unannounced primary focus on anatomy.ResultsStudents who dissected the truncal regions of the human body succeeded in answering the questionnaire with high success. Students dissecting regions of the Head/Neck or Limbs had a high failure rate, and none of them reached the “high” success level. In the MCQ exam, students dissecting truncal regions had a high success rate, while those who had not dissected or who dissected the Head/Neck or Limbs had a high failure rate.ConclusionDissections support and improve the required knowledge for surgical modules. For the visceral surgical module, students dissecting the region prior to the module greatly benefited. Therefore, entire human body dissection assumes to be preferable.

Replacing a Veterinary Physiology Endocrinology Lecture with a Blended Learning Approach Using an Everyday Analogy

Understanding scientific concepts and processes is critical for veterinary education. This article outlines the impact of blended learning and the use of an analogy on student understanding of the hypothalamic-pituitary-target gland axis over a three-year period. The first-year veterinary physiology course at our institution was modified to incorporate a blended learning approach. An analogy centered around a fast-food restaurant was introduced via an animated video to explain key concepts using an online module. Students completed the module on their own time and class time was optional for asking questions or obtaining clarification as needed. Learning was assessed using the same set of multiple-choice exam questions (MCQs). As hypothesized, students using the online module performed equally well (significantly better for those in the lower quartile) on three summative MCQs to those who received the same information delivered by traditional lecture. Student feedback identified positive aspects regarding blended learning using the analogy, including dynamic visuals, ability to work at their own time and pace, and ease of repeating information. Students cited lack of discipline and poor time management as obstacles to completing the module. Changing the anatomy and physiology of the hypothalamus and pituitary gland from static images and text to an animated video significantly improved student's preference for the blended learning approach. Blended learning and the analogy was preferred by 47% of students over the traditional lecture format (21% preferred traditional lecture and 32% were indifferent) and it was more effective in helping students master this important physiological concept.