Multiple-choice Exam Questions Research Articles

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.
 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<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.
 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% & 5.1% respectively based on response frequency criterion alone, compared to: 8.2%, 12.3%, 28.7%, 35.2% & 15.7% respectively when using any of the two criterion for NED definition.
 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.

Do local curriculum scores correlate with national residency test results? A pluriannual, nationwide survey of Italian Medical Universities

In Italy, to match medical doctors to specialty residencies, the Minister of Education organizes a national multiple choice questions exam composed of 140 items. The curriculum grants additional points based on the candidates’ grade average and graduation mark. Both national and international policies assume that curriculum scores can be evaluated in absolute terms, irrespective of the course attended by the candidate or its University of graduation. A fair inquiry over the current criteria of selection is not available to this day. Hence, this study aimed at investigating the degree of association between results in the Italian national residency test and the score given for each candidate’s curriculum. We calculated Spearman’s correlation coefficients between the score obtained at the 2019 test and curriculum scores. A moderate/high degree of correlation (rho=0.600) was reached. Spearman’s rho ranged from 0.447 to 0.788, considering the single Universities. We thus measured a modest but non-negligible between-University variability. As differences between test and curriculum scores across institutions may determine the admission or not to the residency for many candidates, the authors call for broader attention on the topic.

Effect of remote online exam delivery on student experience and performance in applied knowledge tests

BackgroundThe use of remote online delivery of summative assessments has been underexplored in medical education. Due to the COVID-19 pandemic, all end of year applied knowledge multiple choice question (MCQ) tests at one UK medical school were switched from on campus to remote assessments.MethodsWe conducted an online survey of student experience with remote exam delivery and compared test performance in remote versus invigilated campus-based forms of similar assessments for Year 4 and 5 students across two academic years.ResultsVery few students experienced technical or practical problems in completing their exam remotely. Test anxiety was reduced for some students but increased for others. The majority of students preferred the traditional setting of invigilated exams in a computer lab, feeling this ensured an even playing field for all candidates. Mean score was higher for Year 4 students in the remotely-delivered versus campus-based form of the same exam (76.53% [SD 6.57] vs. 72.81% [6.64]; t438.38 = 5.94, p = 0.001; d = 0.56), whereas candidate performance was equivalent across both forms for Year 5 students.ConclusionsRemote online MCQ exam delivery is an effective and generally acceptable approach to summative assessment, and could be used again in future without detriment to students if onsite delivery is not possible.

Assessing professional competence in optometry \u2013 a review of the development and validity of the written component of the competency in optometry examination (COE)

BackgroundCredentialing assessment for overseas-educated optometrists seeking registration in Australia and New Zealand is administered by the Optometry Council of Australia and New Zealand. The aim was to review the validation and outcomes of the written components of this exam to demonstrate credentialing meets entry-level competency standards.MethodsThe Competency in Optometry Examination consists of two written and two clinical parts. Part 1 of the written exam comprises multiple choice questions (MCQ) covering basic and clinical science, while Part 2 has 18 short answer questions (SAQ) examining diagnosis and management. Candidates must pass both written components to progress to the clinical exam. Validity was evaluated using Kane’s framework for scoring (marking criteria, item analysis), generalization (blueprint), extrapolation (standard setting), and implications (outcome, including pass rates). A competency-based blueprint, the Optometry Australia Entry-level Competency Standards for Optometry 2014, guided question selection with the number of items weighted towards key competencies. A standard setting exercise, last conducted in 2017, was used to determine the minimum standard for both written exams. Item response theory (Rasch) was used to analyse exams, produce reliability metrics, apply consistent standards to the results, calibrate difficulty across exams, and score candidates.ResultsData is reported on 12 administrations of the written examination since 2014. Of the 193 candidates who sat the exam over the study period, 133 (68.9%) passed and moved on to the practical component. Ninety-one (47.2%) passed both the MCQ and SAQ exams on their first attempt. The MCQ exam has displayed consistently high reliability (reliability index range 0.71 to 0.93, average 0.88) across all 12 administrations. Prior to September 2017 the SAQ had a set cutscore of 50%, and the difficulty of the exam was variable. Since the introduction of Rasch analysis to calibrate difficulty across exams, the reliability and power of the SAQ exam has been consistently high (separation index range 0.82 to 0.93, average 0.86).ConclusionsThe findings from collective evidence support the validity of the written components (MCQ and SAQ) of the credentialing of the competency of overseas-educated optometrists in Australia and New Zealand.

Undergraduate neurology teaching: Comparison of an inpatient versus outpatient clinical setting.

Neurology is often perceived as a difficult discipline by medical students, yet it is an essential part of medical training. While the most common disorders of the nervous system can be observed in the outpatient setting, positive neurological signs are more likely to be found in neurology wards. We aimed to compare the impact of a neurology outpatient versus inpatient rotation setting on the grades obtained by medical students as a proxy measure of the learning outcomes. We compared the results obtained by fourth year medical students in practical (OSCE) and multiple choice question (MCQ) exams in neurology, between students whose main (total of 24h contact) teaching allocation was either the outpatient or inpatient setting, controlling for students' gender, teacher, academic year and student' previous achievement (measured by their scores on practical evaluation). A total of 1127 students were included, of whom 644 (57.14%) were allocated mainly to the neurology ward and 483 (42.86%) to the outpatient clinic. Students assigned to the ward obtained significantly higher grades in the OSCE and MCQ exams than those placed in the outpatient clinic. Teaching setting was an independent predictor of both classifications after adjustment. The teaching setting had a significant impact on the learning outcomes. This may be due to a higher likelihood of observing abnormal neurological signs or to more student-centered teaching on the ward. These results highlight the importance of a balanced distribution of students by different clinical settings.

Albert Einstein College of Medicine.

Albert Einstein College of Medicine.

Pattern-Based Learning: An Educational Model for Radiology Assistants

Background: Studies show that planning, strategy making, and modeling have greater impact on the achievement of learners than other educational factors. The aim of the present study was to evaluate the changes in clinical competency of radiology residents by teaching and training educational models of radiologic Pattern recognition - diagnostic Approach - Feedback on diagnosis (PAF). Methods: This semi-experimental study was performed at Mashhad University of Medical Sciences from 2018 up to 2020. The participants were 60 radiology residents divided randomly into two groups of 30 subjects in two educational centers. Eight training sessions were held at one of the two educational centers for teaching this model to assistants. Then, the clinical competency of residents was evaluated by four exams. In addition, residents' satisfaction was also determined by a confidential survey conducted by the university. The parametric tests were used for data analysis. p Results: Comparison of the scores of two groups in OSCE exam showed that in the second and third-year of being assistance, the scores of the intervention group were significantly better than the control group (P=0.02 & 0.05), but no significant difference was found between the two groups in the formative (qualitative) and multiple-choice question exams. About 82.7% of radiology residents were satisfied with this educational model. Conclusion: Pattern-based learning, including PAF, is a practical suggestion for problem-based learning in medical imaging. It can lead to improvement of the clinical competency in radiology residents, especially levels 2 or 3.

Immediate feedback assessment technique (IF-AT) quizzes and student performance in microeconomic principles courses

In this study, the authors investigate the impact of the Immediate Feedback Assessment Technique (IF-AT) on student learning outcomes in principles of microeconomics classes. The IF-AT enables students to receive immediate feedback and to retry questions for partial credit. The authors use a randomized experiment to evaluate the effect of the IF-AT versus a traditional Scantron quiz on student learning as measured by exam performance. The randomization enables a student-fixed effects estimation of the effect of the IF-AT. There is no significant impact of the IF-AT on multiple choice exam questions; however, students scored 2.1 percentage points higher on short answer questions relating to units for which they received an IF-AT quiz relative to other units. Finally, students responded favorably to the IF-AT format.

QUALITY AND FEATURE OF MULTIPLE-CHOICE QUESTIONS IN EDUCATION

The quality of multiple-choice questions (MCQs) as well as the student's solve behavior in MCQs are educational concerns. MCQs cover wide educational content and can be immediately and accurately scored. However, many studies have found some flawed items in this exam type, thereby possibly resulting in misleading insights into students’ performance and affecting important decisions. This research sought to determine the characteristics of MCQs and factors that may affect the quality of MCQs by using item response theory (IRT) to evaluate data. For this, four samples of different sizes from US and China in secondary and higher education were chosen. Item difficulty and discrimination were determined using item response theory statistical item analysis models. Results were as follows. First, only a few guessing behaviors are included in MCQ exams because all data fit the two-parameter logistic model better than the three-parameter logistic model. Second, the quality of MCQs depended more on the degree of training of examiners and less on middle or higher education levels. Lastly, MCQs must be evaluated to ensure that high-quality items can be used as bases of inference in middle and higher education. Keywords: higher education, item evaluation, item response theory, multiple-choice test, secondary education

THE EFFECT OF TIME CONSTRAINT ON STUDENT READING COMPREHENSION TEST PERFORMANCE IN NARRATIVE TEXT

The objective of this study was to know whether there is any effect between the time constraints of students when doing exams using (extended time) with students who take exams using (non-extended time). The sample used in this study amounted to 60 grade 11 students in SMA 03 Kaur. The method used in this research was the quantitative method and uses ex post facto design. In collecting data the author gives multiple-choice exam questions consisting of 50 questions, these are questions in the form of narrative texts. In analyzing the data, the authors used the Mann Whitney U-Test in SPSS 16.0. The results of this study indicate that the influence of time constraints on student examinations using extended time.

Item Analysis of Islamic Education For Class VIII at Junior High School 1 Jetis Ponorogo

Education is a conscious activity that is intentional and planned to achieve a goal, then to achieve these objectives it is necessary to evaluate. The success of the evaluation activity can be seen from the making of questions, the implementation of the test and how the teacher can process the results of the test. The study’s aims to determine the quality of the items of the Midterm Exam for Islamic Religious Education 7 th grade at Junior High School 1 Jetis Ponorogo 2019/2020 Academic Year in terms of validity, reliability, difficulty level, and different power. This research is a descriptive qualitative research. The object of this study is the Midterm Exam Subjects for Islamic Religious Education 7 th grade at Junior High School 1 Jetis Ponorogo Academic Year 2019/2020 consisting of 20 multiple choice exam questions and 5 test items for essay/essay. The data collection technique this time uses the documentation method in the form of midterm examination scores. The results showed that: (1) the validity test, for multiple choice questions totaling 20 items in total was declared valid, as well as for the problem description / essay which totaled 5 items in total were declared valid. (2) the reliability test, in the form of multiple choice questions have a low reliability index of 0.654, as well as for the form of description / essay questions have a low reliability index of 0.529. (3) difficult level test, the form of multiple choice questions categorized as hard is 1 item (5%), 13 items (65%), easy 6 items (30%) and for the form of questions / essay questions are not available, while 3 items are (60%), easily 2 items (40%). (4) different power test problems, the form of multiple choice questions categorized as bad 6 items (30%), enough 13 items (65%), good 1 item (5%), very good none and for the form of question items / essays categorized as bad 1 item (20%), enough 2 items (40%), good 2 items (20%) absolutely nothing. (5) the quality of items in multiple choice questions including good quality is 14 items (70%), the quality is quite good 2 items (10%), and the quality is not good 4 items (20%) and for the description / essay questions included good quality is 3 items (60%), good quality is 1 item (20%), and quality is not good 1 item (20%). Based on the findings, then to improve the quality of the midterm examination even in the Islamic Religious Education subjects of 7 th grade at Junior High School 1 Jetis Ponorogo, teachers should pay more attention to the item indicators both in terms of validity, reliability, difficulty level and different power of items to be tested.

Sound Practices: An Exploratory Study of Building and Monitoring Multiple-Choice Exams at Canadian Undergraduate Medical Education Programs.

Written examinations such as multiple-choice question (MCQ) exams are a key assessment strategy in health professions education (HPE), frequently used to provide feedback, to determine competency, or for licensure decisions. However, traditional psychometric approaches for monitoring the quality of written exams, defined as items that are discriminant and contribute to increase the overall reliability and validity of the exam scores, usually warrant larger samples than are typically available in HPE contexts. The authors conducted a descriptive exploratory study to document how undergraduate medical education (UME) programs ensure the quality of their written exams, particularly MCQs. Using a qualitative descriptive methodology, the authors conducted semistructured interviews with 16 key informants from 10 Canadian UME programs in 2018. Interviews were transcribed, anonymized, coded by the primary investigator, and co-coded by a second team member. Data collection and analysis were conducted iteratively. Research team members engaged in analysis across phases, and consensus was reached on the interpretation of findings via group discussion. Participants focused their answers around MCQ-related practices, reporting using several indicators of quality such as alignment between items and course objectives and psychometric properties (difficulty and discrimination). The authors clustered findings around 5 main themes: processes for creating MCQ exams, processes for building quality MCQ exams, processes for monitoring the quality of MCQ exams, motivation to build quality MCQ exams, and suggestions for improving processes. Participants reported engaging multiple strategies to ensure the quality of MCQ exams. Assessment quality considerations were integrated throughout the development and validation phases, reflecting recent work regarding validity as a social imperative.

Transitioning from Traditional Fill‐In to Multiple Choice Question (MCQ) Format for Anatomy Practical Examinations: Should We?

United States medical schools are moving to multiple choice‐style assessments, away from traditional fill‐in, for anatomy practical exams. Practical exams for medical students have long consisted of identifying anatomical structures and writing the answer on an answer sheet. This study reports several aspects of this change at two medical schools: New York Medical College and SUNY Downstate Health Sciences University. The report also documents the evolution of opinion of faculty, teaching assistants [TAs] and students with respect to the benefits of each testing modality. Student t‐tests were used to compare test score data between the two testing modalities employed at each institution. Results showed there were no statistically significant differences between fill‐in and MCQ mean scores for NY Med (5 years of fill‐in vs 5 years of MCQ) and Downstate (5 years of fill‐in vs one year of MCQ), 0.5 and 0.7 (p < 0.05), respectively. Resistance and support for the transition from faculty, TAs and students were common from both schools irrespective of constancy in student performance between the two testing formats. The quantitative results were surprising as an expected increase in the statistical mean in the MCQ format did not occur. Logistical and pedagogical merits of each exam format were assessed. Faculty and TAs resistant to MCQ exams predicted that offering choices would provide an advantage, as there would be a 25% chance of having a correct choice against the binary of a correct or incorrect written answer. TAs felt that a fill‐in format tapped into a higher cognitive level to reach the correct answer. Students with English as their second language, on the other hand, strongly supported the MCQ exam format. MCQ exams had the benefit of being corrected within 10 minutes of submission with Item Analysis accompanying the report allowing identification of poorly tagged questions and providing the opportunity to make corrections in real time for the entire class. Effectively assessing medical student competence must be addressed in contemporary curriculum design but is MCQ a reliable way to do so?