How to write good multiple choice questions.
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Biomedical subjects
Publications and source records attributed to K R Cox.
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Multiple-choice questions classified as requiring problem-solving skills have been interpreted as measuring problem-solving skills within students, with the implicit hypothesis that questions needing an increasingly complex intellectual process should present increasing difficulty to the student. This hypothesis was tested in a 150-question paper taken by 721 students in seven Australian medical schools. No correlation was observed between difficulty and assigned process. Consequently, the question-answering process was explored with a group of final-year students. Anecdotal recall by students gave heavy weight to knowledge rather than problem solving in answering these questions. Assignment of the 150 questions to the classification by three teachers and six students showed their congruence to be a little above random probability.
The conduct of College examinations has seemed a mystery to many candidates. Both candidates and supervisors of training have echoed this concern with the R.A.C.S. new Part 1 examination. This paper describes the work of the Board of Examiners of the Royal Australasian College of Surgeons and the procedures by which the new Part 1 examination is constructed, administered, analysed and refined. It sets out how the examination has been developed into an educational instrument to provide feedback to candidates, to teachers and to examiners, so that each can improve his performance. In addition, the Board has acquired data from each candidate on his learning opportunities, and from each candidate's mentor on various performance characteristics of the candidate.
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The setting out of management problems in the sequence of question--evidence--action follows practice realities in many situations more closely than the inductive sytle of evidence--diagnosis--action. Explicit setting out of the decision-making process provides a framework for clearer role-identification for different practice specialities, with the opportunity for closer cooperation and joint investigation. Sequential investigation and decision-making separate categories of patients. This streaming can maximize efficiency of investigation and minimize wasteful over-investigation. Teaching a sequential approach to diagnosis and management provides the student with a practical method for solving problems in the real world. If every investigation sought must be justified in terms of the specific question it is to answer, the student will be trained to avoid unnecessary investigation, and the young graduate will find it more difficult to "procrastinate by investigation" because of inability to face up to decision-making.
Regional perfusion has been carried out in the limbs of a group of patients with recurrent melanoma, and has achieved disappearance of visible disease in the affected limb in 10 patients out of 28 (36%), prevention of local recurrence in five, and no effect on the disease in nine. This control of recurrent melanoma cost no mortality, but did carry a definite but acceptable morbidity.
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