Coderre Sylvain P, Harasym Peter, Mandin Henry, Fick Gordon
Department of Medicine, University of Calgary, Health Sciences Centre, 3330 Hospital Drive NW, T2N 4N1, Calgary, Alberta, Canada.
BMC Med Educ. 2004 Nov 5;4:23. doi: 10.1186/1472-6920-4-23.
Pencil-and-paper examination formats, and specifically the standard, five-option multiple-choice question, have often been questioned as a means for assessing higher-order clinical reasoning or problem solving. This study firstly investigated whether two paper formats with differing number of alternatives (standard five-option and extended-matching questions) can test problem-solving abilities. Secondly, the impact of the alternatives number on psychometrics and problem-solving strategies was examined.
Think-aloud protocols were collected to determine the problem-solving strategy used by experts and non-experts in answering Gastroenterology questions, across the two pencil-and-paper formats.
The two formats demonstrated equal ability in testing problem-solving abilities, while the number of alternatives did not significantly impact psychometrics or problem-solving strategies utilized.
These results support the notion that well-constructed multiple-choice questions can in fact test higher order clinical reasoning. Furthermore, it can be concluded that in testing clinical reasoning, the question stem, or content, remains more important than the number of alternatives.
笔试考试形式，尤其是标准的五选项多项选择题，常被质疑是否是评估高阶临床推理或问题解决能力的有效方式。本研究首先调查了两种具有不同选项数量的笔试形式（标准五选项和扩展匹配题）是否能够测试问题解决能力。其次，研究了选项数量对心理测量学及问题解决策略的影响。
采用出声思维协议，以确定专家和非专家在回答两种笔试形式的胃肠病学问题时所使用的问题解决策略。
两种形式在测试问题解决能力方面表现出同等能力，而选项数量对心理测量学或所采用的问题解决策略没有显著影响。
这些结果支持了这样一种观点，即精心设计的多项选择题实际上可以测试高阶临床推理能力。此外，可以得出结论，在测试临床推理时，题干或内容比选项数量更为重要。
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