Dataset Information

Evaluation of an Intervention to Improve Quality of Single-best Answer Multiple-choice Questions.

ABSTRACT:

Introduction

Despite the ubiquity of single-best answer multiple-choice questions (MCQ) in assessments throughout medical education, question writers often receive little to no formal training, potentially decreasing the validity of assessments. While lengthy training opportunities in item writing exist, the availability of brief interventions is limited.

Methods

We developed and performed an initial validation of an item-quality assessment tool and measured the impact of a brief educational intervention on the quality of single-best answer MCQs.

Results

The item-quality assessment tool demonstrated moderate internal structure evidence when applied to the 20 practice questions (?=.671, p<.001) and excellent internal structure when applied to the true dataset (?=0.904, p<.001). Quality scale scores for pre-intervention questions ranged from 2-6 with a mean ± standard deviation (SD) of 3.79 ± 1.23, while post-intervention scores ranged from 4-6 with a mean ± SD of 5.42 ± 0.69. The post-intervention scores were significantly higher than the pre-intervention scores, x ²(1) =38, p <0.001.

Conclusion

Our study demonstrated short-term improvement in single-best answer MCQ writing quality after a brief, open-access lecture, as measured by a simple, novel, grading rubric with reasonable validity evidence.

SUBMITTER: Scott KR

PROVIDER: S-EPMC6324722 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Publications

Evaluation of an Intervention to Improve Quality of Single-best Answer Multiple-choice Questions.

Scott Kevin R KR King Andrew M AM Estes Molly K MK Conlon Lauren W LW Jones Jonathan S JS Phillips Andrew W AW

The western journal of emergency medicine 20181203 1

<h4>Introduction</h4>Despite the ubiquity of single-best answer multiple-choice questions (MCQ) in assessments throughout medical education, question writers often receive little to no formal training, potentially decreasing the validity of assessments. While lengthy training opportunities in item writing exist, the availability of brief interventions is limited.<h4>Methods</h4>We developed and performed an initial validation of an item-quality assessment tool and measured the impact of a brief ...[more]

PMID: 30643595

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Project description:During the preclinical years, single-best-answer multiple-choice questions (SBA-MCQs) are often used to test the higher-order cognitive processes of medical students (such as application and analysis) while simultaneously assessing lower-order processes (like knowledge and comprehension). Consequently, it can be difficult to pinpoint which learning outcome has been achieved or needs improvement. We developed a new scoring system for SBA-MCQs using a step-by-step methodology to evaluate each learning outcome independently. Enrolled in this study were third-year medical students (n = 316) who had registered in the basic microbiology course at the Faculty of Medicine, Siriraj Hospital, Mahidol University during the academic year 2017. A step-by-step SBA-MCQ with a new scoring system was created and used as a tool to evaluate the validity of the traditional SBA-MCQs that assess two separate outcomes simultaneously. The scores for the two methods, in percentages, were compared using two different questions (SBA-MCQ1 and SBA-MCQ2). SBA-MCQ1 tested the students' knowledge of the causative agent of a specific infectious disease and the basic characteristics of the microorganism, while SBA-MCQ2 tested their knowledge of the causative agent of a specific infectious disease and the pathogenic mechanism of the microorganism. The mean score obtained with the traditional SBA-MCQs was significantly lower than that obtained with the step-by-step SBA-MCQs (85.9% for the traditional approach versus 90.9% for step-by-step SBA-MCQ1; p < 0.001; and 81.5% for the traditional system versus 87.4% for step-by-step SBA-MCQ2; p < 0.001). Moreover, 65.8% and 87.8% of the students scored lower with the traditional SBA-MCQ1 and the traditional SBA-MCQ2, respectively, than with the corresponding sets of step-by-step SBA-MCQ questions. These results suggest that traditional SBA-MCQ scores need to be interpreted with caution because they have the potential to underestimate the learning achievement of students. Therefore, the step-by-step SBA-MCQ is preferable to the traditional SBA-MCQs and is recommended for use in examinations during the preclinical years.

Project description:Multiple choice questions (MCQs) offer high reliability and easy machine-marking, but allow for cueing and stimulate recognition-based learning. Very short answer questions (VSAQs), which are open-ended questions requiring a very short answer, may circumvent these limitations. Although VSAQ use in medical assessment increases, almost all research on reliability and validity of VSAQs in medical education has been performed by a single research group with extensive experience in the development of VSAQs. Therefore, we aimed to validate previous findings about VSAQ reliability, discrimination, and acceptability in undergraduate medical students and teachers with limited experience in VSAQs development. To validate the results presented in previous studies, we partially replicated a previous study and extended results on student experiences. Dutch undergraduate medical students (n = 375) were randomized to VSAQs first and MCQs second or vice versa in a formative exam in two courses, to determine reliability, discrimination, and cueing. Acceptability for teachers (i.e., VSAQ review time) was determined in the summative exam. Reliability (Cronbach's α) was 0.74 for VSAQs and 0.57 for MCQs in one course. In the other course, Cronbach's α was 0.87 for VSAQs and 0.83 for MCQs. Discrimination (average Rir) was 0.27 vs. 0.17 and 0.43 vs. 0.39 for VSAQs vs. MCQs, respectively. Reviewing time of one VSAQ for the entire student cohort was ±2 minutes on average. Positive cueing occurred more in MCQs than in VSAQs (20% vs. 4% and 20.8% vs. 8.3% of questions per person in both courses). This study validates the positive results regarding VSAQs reliability, discrimination, and acceptability in undergraduate medical students. Furthermore, we demonstrate that VSAQ use is reliable among teachers with limited experience in writing and marking VSAQs. The short learning curve for teachers, favourable marking time and applicability regardless of the topic suggest that VSAQs might also be valuable beyond medical assessment.

Project description:OBJECTIVES:The study aimed to compare candidate performance between traditional best-of-five single-best-answer (SBA) questions and very-short-answer (VSA) questions, in which candidates must generate their own answers of between one and five words. The primary objective was to determine if the mean positive cue rate for SBAs exceeded the null hypothesis guessing rate of 20%. DESIGN:This was a cross-sectional study undertaken in 2018. SETTING:20 medical schools in the UK. PARTICIPANTS:1417 volunteer medical students preparing for their final undergraduate medicine examinations (total eligible population across all UK medical schools approximately 7500). INTERVENTIONS:Students completed a 50-question VSA test, followed immediately by the same test in SBA format, using a novel digital exam delivery platform which also facilitated rapid marking of VSAs. MAIN OUTCOME MEASURES:The main outcome measure was the mean positive cue rate across SBAs: the percentage of students getting the SBA format of the question correct after getting the VSA format incorrect. Internal consistency, item discrimination and the pass rate using Cohen standard setting for VSAs and SBAs were also evaluated, and a cost analysis in terms of marking the VSA was performed. RESULTS:The study was completed by 1417 students. Mean student scores were 21 percentage points higher for SBAs. The mean positive cue rate was 42.7% (95% CI 36.8% to 48.6%), one-sample t-test against ≤20%: t=7.53, p<0.001. Internal consistency was higher for VSAs than SBAs and the median item discrimination equivalent. The estimated marking cost was £2655 ($3500), with 24.5 hours of clinician time required (1.25 s per student per question). CONCLUSIONS:SBA questions can give a false impression of students' competence. VSAs appear to have greater authenticity and can provide useful information regarding students' cognitive errors, helping to improve learning as well as assessment. Electronic delivery and marking of VSAs is feasible and cost-effective.

Project description:Finding current best evidence for clinical decisions remains challenging. With 3,000 new studies published every day, no single evidence-based resource provides all answers or is sufficiently updated. McMaster Premium LiteratUre Service--Federated Search (MacPLUS FS) addresses this issue by looking in multiple high quality resources simultaneously and displaying results in a one-page pyramid with the most clinically useful at the top. Yet, additional logistical and educational barriers need to be addressed to enhance point-of-care evidence retrieval. This trial seeks to test three innovative interventions, among clinicians registered to MacPLUS FS, to increase the quantity and quality of searching for current best evidence to answer clinical questions.In a user-centered approach, we designed three interventions embedded in MacPLUS FS: (A) a web-based Clinical Question Recorder; (B) an Evidence Retrieval Coach composed of eight short educational videos; (C) an Audit, Feedback and Gamification approach to evidence retrieval, based on the allocation of 'badges' and 'reputation scores.' We will conduct a randomized factorial controlled trial among all the 904 eligible medical doctors currently registered to MacPLUS FS at the hospitals affiliated with McMaster University, Canada. Postgraduate trainees (n=429) and clinical faculty/staff (n=475) will be randomized to each of the three following interventions in a factorial design (AxBxC). Utilization will be continuously recorded through clinicians’ accounts that track logins and usage, down to the level of individual keystrokes. The primary outcome is the rate of searches per month per user during the six months of follow-up. Secondary outcomes, measured through the validated Impact Assessment Method questionnaire, include: utility of answers found (meeting clinicians’ information needs), use (application in practice), and perceived usefulness on patient outcomes.Built on effective models for the point-of-care teaching, these interventions approach evidence retrieval as a clinical skill. If effective, they may offer the opportunity to enhance it for a large audience, at low cost, providing better access to relevant evidence across many top EBM resources in parallel.ClinicalTrials.Gov NCT02038439.

Dataset Information

Evaluation of an Intervention to Improve Quality of Single-best Answer Multiple-choice Questions.

Introduction

Methods

Results

Conclusion

Publications

Evaluation of an Intervention to Improve Quality of Single-best Answer Multiple-choice Questions.

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