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Indian Journal of Surgery, Vol. 66, No. 4, July-August, 2004, pp. 246-248 View Point Why MCQ Srivastava Anurag, Dhar Anita, Aggarwal ChanderS Department of Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110029 Code Number: is04063 ABSTRACT MCQs emphasize recall of factual information rather than conceptual understanding and integration of concepts. We do not need medical students who are encyclopedia of scientific trivia and memorize information that can be stored and retrieved in seconds using palmtops. We do need students skilled in data analysis, critical thinking and clinical problem solving. Based on concept of free recall the questions may be structured as open ended. The authors hope that this suggestion would provoke healthy criticism in the arena of Medical Education.KEY WORDS:Education, multiple choice questions The point we wish to bring home is that there are many clinical scenarios where neither 4 diagnostic or therapeutic options are offered nor are they necessary. Moreover the 4 possible answers in a MCQ arouse a feeling in the mind of a trainee doctor that when confronted with a clinical problem, someone will offer her 4 possible options. Because the correct answer is offered to the student it is only a matter of simple recall or guess rather than reasoning that she would choose a correct one if she has read the subject or has common sense. A large number of educational research studies have demonstrated poor validity of MCQ′s. Barrows and Tamblyn in their book on Problem Based Learning mention, multiple choice /true false questions under the heading "reliable evaluation tools with questionable validity", in their ability to assess the clinical reasoning process or clinical competence.[1] The issue of validity is the major drawback of MCQ or true false format. It seems quite evident from many studies that the basic behavior evaluated is pure recall of information. Even in cleverly designed questions, asking students to interpret the data and make diagnostic/therapeutic decisions, the correct choice is always in front of him/her. There is no evidence that pure recall of information, in anyway correlates with competence in clinical reasoning or the care of patients. This format certainly cannot evaluate, inquiry strategy, problem formulation, skills or any clinical or interpersonal skills. Newble et al. compared the performance of different groups of students and doctors on identical and equivalent tests set in an objective-type format and in a free-response format. In all test situations candidates′ scores were significantly higher in the objective tests than in the free-response tests.[2] This difference was greater for the more junior and less competent students than for the more competent doctors. The cueing effect of the options was thought to be the main factor responsible for the difference in performance. A large majority of the students believed that the free-response tests gave a more accurate assessment of their clinical ability. For measuring clinical competence, multiple-choice questions appeared to overestimate the candidate′s ability to an extent that made them less suitable than free-response questions for this purpose. It was concluded that the written component of the final examination in the medical course should have a preponderance of free-response items over multiple-choice items. Nelson asserts that assessment should mimic how students will be evaluated on the job site in the real world, meaning that they should be team members and problem solvers, with the technological and academic skills to communicate the results of their actions.[3] They introduced the concept of "authentic assessment," a process that requires that the evaluation be realistic and force the students to use knowledge to solve real-world problems, which are often open-ended, poorly framed, and have no clear-cut answers. Elstein confesses that for any one examinee we cannot know whether a particular question was answered by rapid retrieval of overlearned content (i.e. rote memory) or by more abstract, purposeful relating of principles.[4] Another problem with MCQ is the issue of "one correct answer." There are clinical and basic science situations where more than one answer may be correct. Since the response is limited to a selection from a short list of options, we can not assess directly how the examinee reflected upon or deliberated about the alternatives, but in controversial cases, that is precisely what we wish to know. Structured MCQs tap mainly recognition memory but the structure of knowledge is better revealed by free-recall tasks than by recognition tasks. In an attempt to overcome the disadvantages of the conventional examination an objective structured clinical examination (OSCE) was introduced in surgery at the University of Dundee (Cuschieri et al).[5] In this approach students are tested at 20 stations through which the candidates rotate. This approach to the final examination is more reliable and more valid than traditional methods. Introduction of OSCE in examination has made reliable and positive changes in the assessment. Therefore there is a need felt to change the traditional MCQ pattern for assessment in theory examination. Innovations have been described to improve the quality of MCQs. Khan et al introduced a web-based formative assessment system.[6] It consists of knowledge tests based on multiple true-false questions, capable of monitoring students′ educational progress on an individual basis or as small groups and providing feedback. Kennedy et al report on an Open-Ended, Short Answer, Text Question Tool (TQT).[7] They developed a learning element for computer-facilitated learning (CFL) module. The learning element is an open-ended, short answer, TQT for Web-based courses or incorporated into hybrid Web/CD-ROM systems. The TQT object facilitates the development of extended question-and-answer problems which overcome the limitations of multiple choice question. The examiners should be cognizant of the shortcomings of MCQ. They create an artificial scenario in the trainee′s mind that she will be offered 4 options for a clinical problem. In the real life she may have to work alone in a remote health center and forced to take all the diagnostic and therapeutic decisions on her own. It is therefore suggested that MCQ′s be abolished from medical examinations and perhaps all examinations and be replaced with free response or short answer questions. The idea may seem a bit too radical in the beginning but will have long lasting repercussions in the way we assess the knowledge & competence of our undergraduates. Few students solve the MCQ as follows: out of 4 responses, they excluded 2 by simple common sense and for the remaining 2, they toss a coin. Abolishment of MCQ will stop such guessing in the exam. Based on concept of free recall the questions may be structured as open ended. The question can be framed such that there are more than one answers, since it is difficult to design questions with single perfect answer. e.g., Write down four complications related to blood transfusion: MCQ′s emphasize recall of factual information rather than conceptual understanding and integration of concepts. We do not need medical students who are encyclopedia of scientific trivia and memorize information that can be stored and retrieved in seconds using palmtops. We do need students skilled in data analysis and critical thinking. The authors hope that this suggestion would provoke healthy criticism in the arena of Medical Education. REFERENCES
Copyright 2004 - Indian Journal of Surgery |
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