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M(odified) E(ssay) Q(uestions) for Medicine Finals

• Edited by: 
• Derrick Wee Aw Chen ( National University Hospital, Singapore )  and 
• Chin Meng Khoo ( National University Hospital, Singapore )
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• Description
• Supplementary

There is a paucity of high-value examination-style questions for final-year medical undergraduates. This book uses true (and modified) clinical scenarios (for realism), appropriate and pragmatic clinical questions (for clinical reasoning), and provides readers with explanations and tips in solutions (for self-reflection). The good reception received from Vol. 1 is the main stimulus for this Vol. 2.

The book will useful for:

• Final-year exam preparation for Medicine undergraduates around the world
• Junior residents to evaluate their own knowledge and approaches in internal medicine
• Senior doctors in providing inspiration and ideas for setting examination questions

The book includes:

• Challenging and realistic clinical questioning
• Comprehensive solutions (which include wrong answers that candidates may give)
• Useful examination-oriented and practice-based tips for selected solutions

Sample Chapter(s) Assessment Paper 1 (803 KB)

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• Ten Specimen Papers each Comprising 5 Structured Questions
• and Tips at the End

FRONT MATTER

• Pages: i–xii

https://doi.org/10.1142/9789813109568_fmatter

• List of Contributors

Assessment Paper 1

• Pages: 2–20

https://doi.org/10.1142/9789813109568_0001

Assessment Paper 2

• Pages: 22–39

https://doi.org/10.1142/9789813109568_0002

Assessment Paper 3

• Pages: 42–59

https://doi.org/10.1142/9789813109568_0003

Assessment Paper 4

• Pages: 62–79

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Assessment Paper 5

• Pages: 82–104

https://doi.org/10.1142/9789813109568_0005

Assessment Paper 6

• Pages: 106–124

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Assessment Paper 7

• Pages: 126–146

https://doi.org/10.1142/9789813109568_0007

Assessment Paper 8

• Pages: 148–169

https://doi.org/10.1142/9789813109568_0008

Assessment Paper 9

• Pages: 172–191

https://doi.org/10.1142/9789813109568_0009

Assessment Paper 10

• Pages: 194–217

https://doi.org/10.1142/9789813109568_0010

• Pages: 219–289

https://doi.org/10.1142/9789813109568_0011

These are the solution papers for Assessment Paper 1 to 10.

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• DOI: 10.1093/PTJ/65.7.1075
• Corpus ID: 23901128

Modified essay question.

• P. Stratford , H. Pierce-Fenn
• Published in Physical Therapy 1 July 1985
• Education, Medicine

Tables from this paper

34 Citations

A case for written examinations in undergraduate medical education: experiences with modified essay examinations, the modified essay question: its exit from the exit examination, the modified essay question: an evaluation of its use in a family medicine clerkship, modified essay questions: cognitive skills assessed and the performance of the fifth-year medical students, preferred question types for computer-based assessment of clinical reasoning: a literature study, the prognostic validity of the formative for the summative meq (modified essay questions), efficiency analysis of two written short-answer student evaluation formats., the structured oral self-directed learning evaluation: one method of evaluating the clinical reasoning skills of occupational therapy and physiotherapy students., computer-based testing of the modified essay question: the singapore experience.

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The modified essay question: effect of author location on student performance

14 references, reliability and validity studies on modified essay questions., the cognitive structure of the modified essay question, evaluation of a comprehensive programme for the assessment of medical students, a comparison of multiple‐choice tests and free‐response tests in examinations of clinical competence, coefficient alpha and the internal structure of tests, the validity and reliability of a new examination of the clinical competence of medical students.

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Statistical analysis in psychology and education. 4th ed.

The modified essay question for testing problem‐solving skills, a new approach to evaluating-problem-solving in medical students., developing oral and written formats for evaluating clinical problems-solving by medical undergraduates., related papers.

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Modified Essay Question or MEQ

Cite this chapter.

• T. A. I. Bouchier Hayes LAH, FRCGP, DRCOG ,
• John Fry OBE, MD, FRCS, FRCGP ,
• Eric Gambrill MB, BS, FRCGP, D.OBST. RCOG ,
• Alistair Moulds MB, CH.B, MRCGP, D.OBST. RCOG &
• K. Young OBE, MB, B.CH, FRCGP, DTM & H, DPH  

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The MEQ is an original development by the examiners of the RCGP of the patient-management problem type of examination format widely used in North America and Australasia. The papers are normally based on a real case and the format is the familiar one in which an evolving clinical problem is unfolded stage by stage. The participant is expected to respond in the appropriate manner by eliciting further information via history or physical examination; speculate on the diagnostic possibilities; order relevant investigations; come to a working diagnosis; advise and counsel the patient and his family; intervene appropriately by mobilising relations, nursing or social services; refer to specialists or prescribe drugs or aids; and show an awareness of risk factors in a situation by demonstrating an ability to anticipate problems which might be expected to arise in the future.

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Hayes, T.A.I.B., Fry, J., Gambrill, E., Moulds, A., Young, K. (1981). Modified Essay Question or MEQ. In: The MRCGP Study Book. Springer, Dordrecht. https://doi.org/10.1007/978-94-015-7174-6_3

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Evaluation of Modified Essay Questions (MEQ) and Multiple Choice Questions (MCQ) as a tool for Assessing the Cognitive Skills of Undergraduate Medical Students

Objectives: Developing and testing the cognitive skills and abstract thinking of undergraduate medical students are the main objectives of problem based learning. Modified Essay Questions (MEQ) and Multiple Choice Questions (MCQ) may both be designed to test these skills. The objectives of this study were to assess the effectiveness of both forms of questions in testing the different levels of the cognitive skills of undergraduate medical students and to detect any item writing flaws in the questions. Methods: A total of 50 MEQs and 50 MCQs were evaluated. These questions were chosen randomly from various examinations given to different batches of undergraduate medical students taking course MED 411-412 at the Department of Medicine, Qassim University from the years 2005 to 2009. The effectiveness of the questions was determined by two assessors and was defined by the question's ability to measure higher cognitive skills, as determined by modified Bloom's taxonomy, and its quality as determined by the presence of item writing flaws. 'SPSS15' and 'Medcalc' programs were used to tabulate and analyze the data. Results: The percentage of questions testing the level III (problem solving) cognitive skills of the students was 40% for MEQs and 60% for the MCQs; the remaining questions merely assessed the recall and comprehension. No significant difference was found between MEQ and MCQ in relation to the type of questions (recall; comprehension or problem solving x 2 = 5.3, p = 0.07).The agreement between the two assessors was quite high in case of MCQ (kappa=0.609; SE 0.093; 95%CI 0.426-0.792) but lower in case of MEQ (kappa=0.195; SE 0.073; 95%CI 0.052-0.338). 16% of the MEQs and 12% of the MCQs had item writing flaws. Conclusion: A well constructed MCQ is superior to MEQ in testing the higher cognitive skills of undergraduate medical students in a problem based learning setup. Constructing an MEQ for assessing the cognitive skills of a student is not a simple task and is more frequently associated with item writing flaws.

Related Papers

Strides in Devlopment of Medical Education

Mohammad Reza Mahmoodi

Objectives: The purpose of this study was to evaluate the improvement of students' ability to answer consecutive patient management problem (PMP) and modified essay question (MEQ) exams, to assess its relationship with academic progress, and to determine whether consecutive PMP-MEQ exams can improve the students' clinical reasoning skills by improving the test scores. Methods: This descriptive, analytical, cross-sectional study consisted of 67 third-year nutrition students in three consecutive years, who were asked to prepare for a multiple-choice question (MCQ) test and consecutive PMP-MEQ exams. The students were required to answer PMP-MEQ exam, which comprised of two queries of five-choice question (PMP) and three short-answer questions (MEQ). Repeated measures ANOVA, independent t-test, paired t-test, and Pearson's correlation test were used for statistical analysis. Results: The mean difference in PMP scores was significant between the three periods (P = 0.0001). However, the difference in the mean score of PMP exam between students with grade point average (GPA) ≥ 16 and GPA < 16 was not significant, except for PMP3 (P = 0.001). An increase was observed in the scores of students in both groups by continuous PMP examination. The significant mean difference in PMP3 exam showed that improvement of students with GPA ≥ 16 was greater than that of students with GPA < 16 (P = 0.001). The difference in the mean scores of MCQ and PMP exams was significant, except for the third PMP exam in students with GPA ≥ 16 (P = 0.143). Conclusions: Use of PMP-MEQ exams in reasoning-based clinical education can be a suitable approach for clinical evaluation of undergraduate students. Also, continuous PMP-MEQ examination can improve the clinical reasoning of students, mainly those with GPA ≥ 16. 1. Background Effective clinical reasoning depends on the health pro-fessional's ability to collect and analyze the right cues or information to reach an accurate understanding of a patient problem or differential diagnosis, to plan and implement the right interventions, and finally to learn from the process (1, 2). Reasoning-and competency-based medical education requires a robust and multi-dimensional assessment system (3). It relies on continuous, inclusive, and elaborate assessment and feedback systems, which facilitate the development of reasoning and competence (4). On the other hand, in most countries, a multiple choice question (MCQ) is the most common assessment method of medical knowledge, followed by modified essay question (MEQ) (5). MCQ does not focus on the evaluation of cognitive skills, and many MCQs assess small sections of textbooks. With the introduction of problem-based learning for the evaluation of clinical reasoning and competence in medical and health professional courses, besides the shift from a traditional lecture-based curriculum to a student-centered one, many schools are currently reviewing their assessment tools and introducing new strategies for evaluating the student (6). In a study, two popular formats of tests, i.e., MCQ and MEQ, were compared. Based on their findings, although MCQ and MEQ may assess different skills, there is a very strong relationship between their content scores (7). In another study, the results of MEQ and MCQ were strongly and positively correlated, and the overall examination showed good reliability and validity. In their study, MEQ included more questions on recall of knowledge, which were more

Sri Lanka Journal of Medicine

Deepthi Edussuriya

International journal of Educational & Psychological Researches

Aim: Assessment is a very important component of the medical course curriculum. Item analysis is the process of collecting, summarizing, and using information from student's responses to assess the quality of multiple-choice questions (MCQs). Difficulty index (P) and discrimination index (D) are the parameters used to evaluate the standard of MCQs. The aim of the study was to assess quality of MCQs. Materials and Methods: The study was conducted in the Department of Pathology. One hundred and twenty, 2nd year MBBS students took the MCQs test comprising 40 questions. There was no negative marking and evaluation was done out of 40 marks, and 50% score was the passing mark. Postvalidation of the paper was done by item analysis. Each item was analyzed for difficulty index, discrimination index, and distractor effectiveness. The relationship between them for each item was determined by Pearson correlation analysis using SPSS 20.0. Results: Difficulty index of 34 (85%) items was in the acceptable range (P = 30–70%), 2 (5%) item was too easy (P >70%), and 4 (10%) items were too difficult (P <30%). Discrimination index of 24 (60%) items was excellent (D >0.4), 4 (10%) items were good (D =0.3–0.39), 6 (15%) items were acceptable (D =0.2–0.29), and 6 (15%) items were poor (D < 0–0.19). A total 40 items had 120 distractors. Amongst these, 6 (5%) were nonfunctional distracters, 114 (95%) were functional distracters. The discrimination index exhibited positive correlation with difficulty index (r = 0.563, P = 0.010, significant at 0.01 level [two-tailed]). The maximum discrimination (D = 0.5–0.6) was observed in acceptable range (P = 30–70%). Conclusion: In this study, the majority of items fulfilled the criteria of acceptable difficulty and good discrimination. Moderately easy/difficult had the maximal discriminative ability. Very difficult item displayed poor discrimination, but the very easy item had high discrimination index, indicating a faulty item, or incorrect keys. The results of this study would initiate a change in the way MCQ test items are selected for any examination, and there should be proper assessment strategy as part of the curriculum development.

International Journal of Medical Research and Review

siddharth banode

Pak J Med Sci

Nighat Huda , DR MUKHTIAR BAIG , Sobia Ali

Objectives: To evaluate Multiple Choice and Short Essay Question items in Basic Medical Sciences by determining item writing flaws (IWFs) of MCQs along with cognitive level of each item in both methods. Methods: This analytical study evaluated the quality of the assessment tools used for the first batch in a newly established medical college in Karachi, Pakistan. First and sixth module assessment tools in Biochemistry during 2009-2010 were analyzed. Cognitive level of MCQs and SEQs, were noted and MCQ item writing flaws were also evaluated. Results: A total of 36 SEQs and 150 MCQs of four items were analyzed. The cognitive level of 83.33% of SEQs was at recall level while remaining 16.67% were assessing interpretation of data. Seventy six percent of the MCQs were at recall level while remaining 24% were at the interpretation. Regarding IWFs, 69 IWFs were found in 150 MCQs. The commonest among them were implausible distracters (30.43%), unfocused stem (27.54%) and unnecessary information in the stem (24.64%). Conclusion: There is a need to review the quality including the content of assessment tools. A structured faculty development program is recommended for developing improved assessment tools that align with learning outcomes and measure competency of medical students.

International Journal Of Community Medicine And Public Health

Abhijeet Ingale

Background: Item analysis is the process of collecting, summarizing and using information from students’ response to assess the quality of test items. However it is said that MCQs emphasize recall of factual information rather than conceptual understanding and interpretation of concepts. There is more to writing good MCQs than writing good questions. The objectives of the study was to assess the item and test quality of multiple choice questions and to deal with the learning difficulties of students, identify the low achievers in the test. Methods: The hundred MBBS students from Government medical college were examined. A test comprising of thirty MCQs was administered. All items were analysed for Difficulty Index, Discrimination Index and Distractor Efficiency. Data entered in MS Excel 2007 and SPSS 21 analysed with statistical test of significance. Results: Majority 80% items difficulty index is within acceptable range. 63% items showed excellent discrimination Index. Distractor e...

INTED Proceedings

Dr Jorge Reyna

For decades, medical education has used Multiple Choice Questions (MCQs) in undergraduate, postgraduate, and specialist training programs. With the development of Learning Management Systems (LMS) in the early 1990s, educators adapted paper-based MCQs for formative and summative assessments. Technology allowed automated feedback, question shuffling, instant marking, and 'branching' based on student responses. With the advent of e-learning authoring tools in the early 2000s, it became possible to create interactive online tests with images, animations, videos, drag-anddrop elements, blanks to fill in, and hotspots. Effective MCQ writing involves understanding educational concepts like learning taxonomies, constructive alignment, approaches to learning, cognitive load, and student motivation to learn. It is also essential when structuring a question to avoid ambiguity and to have the imagination to write MCQs that measure application of knowledge. Whether a basic or advanced topic, it is possible to design MCQs that measure higher-order thinking that require the student to apply their knowledge rather than simply recalling it. MCQs with hypothetical scenarios can measure higher-order thinking and promote deep learning. However, preparing the students for this type of examination is essential to enhance their learning experience. This article discusses the theoretical considerations involved in writing MCQs for medical education which encourage deep learning and improve the student learning experience.

JOURNAL OF CLINICAL SCIENCE AND DIAGNOSTIC RESEARCH

Arijit Datta

ABSTRACT Introduction: Assessments direct students towards learning. There are three types of learning: cognitive, affective, and psychomotor. While all three are interlinked, the cognitive domain, which covers knowledge and intellectuality, is foundational and can be assessed through theory examinations. Theory exams are the best way to test the cognitive domain of a learner, while practical exams can assess the psychomotor and affective domains. Since the question paper is the most important tool in theory exams, it is essential that the question paper covers relevant topics and tests all levels of cognitive learning, which encompass knowledge, comprehension, application, analysis, synthesis, and evaluation. Aim: To assess the level of cognitive domains assessed and the weightage allocated to various topics in the undergraduate summative examination question paper of community medicine. Materials and Methods: A cross-sectional study was conducted at Department of Community Medicine, Pramukh Swami Medical College and Sri Krishna Hospital, Bhaikaka University, Karamsad, Anand, Gujarat, India in which the five-year question papers (2016-2020) from five Universities were analysed to assess the level of cognitive domains and the weightage assigned to various topics. Each question was categorised as recall, comprehension, or application based on the cognitive domain it assessed. Furthermore, each question was analysed to determine the topic it pertained to, and the marks allocated to that question were assigned to the corresponding topic. Results: The majority of marks in Universities 1, 2, 3, 4, and 5 were, respectively allocated as follows: 324 (80.62%), 459 (84.66%), 453 (75.5%), 895 (89.5%), and 379 (63.16%) for questions testing the recall ability of the learners. For questions assessing comprehension ability, the marks allotted were 20 (4.87%), 0, 81 (13.5%), 65 (6.5%), and 51 (8.15%). The fewest marks were assigned to questions testing application, synthesis, or evaluation abilities. Epidemiology had the highest weightage in all five Universities, with marks of 73 (18.25%), 75 (13.89%), 93 (15.5%), 141 (14.1%), and 83 (13.83%). Conclusion: The cognitive domains assessed in the subject across all five Universities were unsatisfactory. The weightage of marks allotted to topics varied, highlighting the need to develop a question paper plan that facilitates a systematic distribution based on different levels of cognitive domains and topics.

BMC Medical Education

Edward Palmer

THE PROFESSIONAL MEDICAL JOURNAL

Sohaib Yousaf

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Evaluation of Modified Essay Questions (MEQ) and Multiple Choice Questions (MCQ) as a tool for Assessing the Cognitive Skills of Undergraduate Medical Students

Objectives:.

Developing and testing the cognitive skills and abstract thinking of undergraduate medical students are the main objectives of problem based learning. Modified Essay Questions (MEQ) and Multiple Choice Questions (MCQ) may both be designed to test these skills. The objectives of this study were to assess the effectiveness of both forms of questions in testing the different levels of the cognitive skills of undergraduate medical students and to detect any item writing flaws in the questions.

A total of 50 MEQs and 50 MCQs were evaluated. These questions were chosen randomly from various examinations given to different batches of undergraduate medical students taking course MED 411–412 at the Department of Medicine, Qassim University from the years 2005 to 2009. The effectiveness of the questions was determined by two assessors and was defined by the question’s ability to measure higher cognitive skills, as determined by modified Bloom’s taxonomy, and its quality as determined by the presence of item writing flaws. ‘SPSS15’ and ‘Medcalc’ programs were used to tabulate and analyze the data.

The percentage of questions testing the level III (problem solving) cognitive skills of the students was 40% for MEQs and 60% for the MCQs; the remaining questions merely assessed the recall and comprehension. No significant difference was found between MEQ and MCQ in relation to the type of questions (recall; comprehension or problem solving x 2 = 5.3, p = 0.07).The agreement between the two assessors was quite high in case of MCQ (kappa=0.609; SE 0.093; 95%CI 0.426 – 0.792) but lower in case of MEQ (kappa=0.195; SE 0.073; 95%CI 0.052 – 0.338). 16% of the MEQs and 12% of the MCQs had item writing flaws.

Conclusion:

A well constructed MCQ is superior to MEQ in testing the higher cognitive skills of undergraduate medical students in a problem based learning setup. Constructing an MEQ for assessing the cognitive skills of a student is not a simple task and is more frequently associated with item writing flaws.

Introduction

The evaluation of the competence of undergraduate medical students is a very critical task, as in the future, these ‘to be physicians’ have to cater with human lives. ( 1 )

At undergraduate level there are three domains of skills to be evaluated i.e. Cognitive, Affective and Psychomotor. Cognitive domain can be evaluated ( 2 ) at different levels including Knowledge, Comprehension, Application, Analysis, Synthesis, and Evaluation. Modified bloom’s taxonomy ( 3 ) identified three levels of cognitive domain. In medical education, the major emphasis is on developing and evaluating the level III or problem solving skills, as most of the physician’s time is spent in analyzing patient’s problems.

Proper cognitive assessment tools reward the students for their higher cognitive skills and abstract thinking. ( 4 ) There are various methods to assess the knowledge domain which include Free response examinations (Long Essay Questions, Short answer Questions, Modified Essay questions), Multiple choice questions, Key feature questions, Self-assessment and peer-assessment. Each of these methods has its pros and cons and is addressed to assess different levels of bloom’s taxonomy. No single method of evaluation is superior to other and probably a reliable and valid evaluation requires a combination of these methods. ( 1 , 4 )

The Multiple choice questions are very popular in evaluation of undergraduate medical students. They are reliable and valid; moreover they are easy to administer to a large number of students. Well constructed MCQs have a greater ability to test knowledge and factual recall but they are less powerful in assessing the problem solving skills of the students. A large proportion of curriculum can be tested in a single sitting. The scoring is very easy and reliable using computer software, but the construction of good MCQs is difficult and needs expertise. Generally MCQs stimulate students to make a superficial and exam oriented study. ( 5 , 6 )

Modified essay questions are short clinical scenarios followed by series of questions with a structured format for scoring. They primarily assess the student’s factual recall but they also assess cognitive skills such as organization of knowledge, reasoning and problem solving. They also address the writing skills and even ethical, social and moral issues and attitudes. MEQs are more flexible and their value is somewhere between essay type questions and MCQ. But they need to be carefully constructed with provision of model answers and training to avoid inter-rater variability. ( 7 , 8 )

In a bird’s eye view, examination and evaluation are a source of anxiety and stress for the undergraduate medical students, but in reality it directs the students to study harder and improve their skills. Therefore, it is imperative not only to stimulate their cognitive skills during the teaching but also to frequently examine their higher mental and reasoning skills. ( 9 , 10 , 11 )

Our objectives were

• To compare MCQ and MEQ in their ability to test different levels of the cognitive domain
• To detect item writing flaws in construction of a question

Material and methods

Study design:.

Cross-sectional survey

50 MCQs and 50 MEQs were chosen randomly from the written examinations delivered to fourth year medical students attending undergraduate internal medicine course at the Department of Medicine, Qassim University. In the 50 MEQs, there were 104 stems. Questions were analyzed individually by two independent assessors as per the ‘preformed criteria’ to label a question with Level I, II or III of the cognitive domain. Questions belonged to various final and midterm examination from 2005 to 2009.

Ethical approval:

No ethical approval was required as no human subjects were involved in the research

Assessment:

Each question was analyzed separately to

Level I Knowledge (recall of information including direct questions asking to check the factual recall, containing words like enumerate; list etc.). Level II Comprehension and application (ability to interpret data; questions including lab data or containing words like analyze). Level III Problem – solving (Use of knowledge and understanding in new circumstances, including scenario based questions which contain case description and lab data asking students to initially make a diagnosis and then to suggest next appropriate investigation; management modalities; counseling etc)

Following were regarded as item writing flaws

• Error in formatting, spelling, grammar
• Technical errors
• Double negatives
• Cascading stems
• Absolute options
• Ambiguous stems
• Repetition of information

The analysis was done by each assessor as per the Performa shown in table (1) .

MCQ /MEQ evaluation form.

Statistical analysis:

Software ‘SPSS 15’ was used for data entry, analysis and interpretation. Kappa test was used to determine the agreement between the two assessors using ‘Med Calc’ software.

Total of 50 questions with 104 stems were included. Analysis is shown in table (2) .

Classification of Questions according to Bloom’s taxonomy.

Total of 50 questions were evaluated. Analysis is shown in table (2) .

Questions were representing different disciplines of Medicine ( graph 1 ). No significant difference was found between MEQ and MCQ in relation to the type of questions (recall; comprehension or problem solving ( x 2 = 5.3, p = 0.07).

The analysis of item writing flaws is shown in table (3) .

illustrates the item flaws of both MEQs and MCQs.

The results of this study show that Multiple choice question is a better test of cognitive skills than the Modified essay question as 60% of the MCQs tested the higher cognitive skills and only 40% of MEQs addressed the cognitive level III of modified Bloom’s taxonomy.

Although when the proportions of the two forms of questions addressing the different levels of cognitive domain were compared, there was no significant statistical difference among the level of cognition tested, as p-value was 0.07. It is also inferred that constructing an MEQ might be technically more difficult than an MCQ as item-writing flaws in MEQs were 16% as compared to MCQ only 12%.

The results of our study are consistent with Edward JP et al 12 who also found MCQ to be superior in testing the level 3 of cognitive domain. The results do not coincide with those of Irwin WG et al 13 who found MEQ to be superior in testing the highest level cognitive skills but they did not choose the questions randomly rather they compared the whole examination papers of various years. They suggest that both MCQ and MEQ may be designed beforehand to test any particular level of Bloom’s taxonomy. Construction of MEQ needs expertise and training, model answers of such questions need meticulous consideration. ( 14 , 15 )

It also seems that some specialty examiners tend to put more stress on Level III testing or it is easier to design such questions for some specialties as most of level III questions in both MCQ and MEQ belonged to cardiology.

It is quite understandable that conduction of a proper assessment is not only dependent on the cognitive aspect of question, but there are so many factors which play a role like, reliability, content and construction validity, financial and human resources.

At the department of Medicine all the questions are constructed by the faculty members then these are put forward to a ‘question review committee’ and after its approval the questions are introduced into the question bank. It was observed during the period of the study that the content and the construction of the questions improved over the years but still individual errors occurred.

The two confounders that played a major role in deciding the level of cognitive domain addressed by each specific type of question were (i) The type of examination to which the question belonged i.e. Midterm or Final (ii) The specialty of the question like cardiology, neurology etc. It may be inferred that in final exams the examiners tend to put the type of questions that address the highest level of cognitive domain (level III) as 80 % of MCQs belonged to the final exams while all MEQs were taken from the Midterm exam papers. This may be one drawback of our study. The total number of questions from which the sample was taken was quite limited which accounts for the small sample size in this study but as more and more questions will be incorporated into the question bank of the department further validation studies will be required.

MCQs were found to be testing the level III of cognitive domain more frequently than MEQs. Training in formulating MCQs and MEQs, more so for MEQs is needed to assure achieving level III of cognitive domain and avoid item writing flaws.

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The medical finals : structured answer and essay questions

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Evaluation of Modified Essay Questions (MEQ) and Multiple Choice Questions (MCQ) as a tool for Assessing the Cognitive Skills of Undergraduate Medical Students

• January 2011
• International Journal of Health Sciences 5(1):39-43

• Qassim College of Medicine

• Mount Sinai Hospital

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