Mapping session learning objectives to exam questions: How to do it and how to apply the results.

The undergraduate pre-clerkship Population Health courses for University of Manitoba medical students underwent a mapping exercise to improve alignment between session learning objectives and the multiple choice questions (MCQs) used for learner assessment. Each learning objective was mapped to all related MCQs in the exam bank. Learning objectives not linked to any specific MCQs were identified. All MCQs in the exam bank were mapped back to the learning objectives and all MCQs not corresponding to a learning objective were identified. In total, 536 MCQ were mapped to 358 learning objectives. Mapping results were shared with course leadership and instructors to affect practical changes in the Population Health courses, such as revisions and improvements to session learning objectives, and targeted development of new MCQs. Following the implementation of changes post-mapping exercise, our findings indicate a significant improvement in student satisfaction with the Population Health courses, although they did not have a discernable impact on exam performance. The mapping exercise required an initial investment of resources, but produced an MCQ database that can be regularly maintained to ensure alignment between learning objectives and assessment, thereby contributing to ongoing curriculum quality and improvement, and improved exam reliability and validity.