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Assessing Pathology Knowledge

When I was still young and full of illusions, I assumed that medical students would be as passionate about pathology as I was and would not need much in terms of incentives to learn the basic characteristics and morphological features of important diseases. It did not take me long to realize that most students are driven by the need to pass exams!

Most exams are presented to medical students in the multiple-choice question (MCQ) format. Students know this and therefore they rapidly develop the skill of efficiently solving MCQs. After some time, they can find the right answer even with minimal real knowledge of the subject at hand, simply by honing their ability to recognize the most likely answer among five possibilities. This raises a question – do MCQ exams test real medical knowledge or just students’ capacity to pass a test by choosing the most likely answers?

There are various approaches to solving this conundrum. The good old oral examination may be considered, but it is time-consuming with large student bodies and almost impossible to standardize. Open-ended or essay questions are subject to the same difficulties. This brings us back to questions with a built-in (set of) answers from which students must choose.

The challenge with MCQs is to make distractors whose likelihood of being correct is (to an uninformed student) more or less equal. Many MCQs tend to be of the simple “recall” type so, instead of understanding the issue at stake, students might recognize a verbal configuration that fits with the core of the question. So what can we do instead?

Two similar test formats may work as MCQ alternatives. The first is the “uncued” question (UCQ). Instead of individual questions with a limited set of answer options, UCQ tests provide a list of questions and a long list of potential answers that tends to look like the index of a pathology textbook. During a timed test, students cannot realistically go through the list to find the right answer; instead, they must conceive of the answer, then find it in the list. The main issue with UCQs lies in the length of the answer list; if it becomes too long, students may not find the correct answer in time – or multiple answers might be considered correct.

The model I have used successfully is an MCQ-UCQ hybrid known as “extended matching.” The questions are similar to MCQs but, instead of five answers, students receive a set of 10 to 20 possible answers in alphabetical order from which they must choose the most correct one. Intrigued? Why not try your hand at a few examples?

Try the “extended matching” quiz here!

This article first appeared in Issue #45 of The Pathologist Educator.

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About the Author
Fred Bosman

Fred Bosman is Professor Emeritus at the University Institute of Pathology, University Medical Center of Lausanne, Switzerland.

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