Stringer J K, Santen Sally A, Lee Eun, Rawls Meagan, Bailey Jean, Richards Alicia, Perera Robert A, Biskobing Diane
Office of Assessment, Evaluation, and Scholarship, Virginia Commonwealth University School of Medicine, Richmond, VA USA.
Office of Integrated Medical Education, Rush Medical College, Chicago, IL USA.
Med Sci Educ. 2021 May 25;31(4):1311-1317. doi: 10.1007/s40670-021-01305-y. eCollection 2021 Aug.
Analytic thinking skills are important to the development of physicians. Therefore, educators and licensing boards utilize multiple-choice questions (MCQs) to assess these knowledge and skills. MCQs are written under two assumptions: that they can be written as higher or lower order according to Bloom's taxonomy, and students will perceive questions to be the same taxonomical level as intended. This study seeks to understand the students' approach to questions by analyzing differences in students' perception of the Bloom's level of MCQs in relation to their knowledge and confidence.
A total of 137 students responded to practice endocrine MCQs. Participants indicated the answer to the question, their interpretation of it as higher or lower order, and the degree of confidence in their response to the question.
Although there was no significant association between students' average performance on the content and their question classification (higher or lower), individual students who were less confident in their answer were more than five times as likely (OR = 5.49) to identify a question as higher order than their more confident peers. Students who responded incorrectly to the MCQ were 4 times as likely to identify a question as higher order than their peers who responded correctly.
The results suggest that higher performing, more confident students rely on identifying patterns (even if the question was intended to be higher order). In contrast, less confident students engage in higher-order, analytic thinking even if the question is intended to be lower order. Better understanding of the processes through which students interpret MCQs will help us to better understand the development of clinical reasoning skills.
分析性思维能力对医生的成长很重要。因此，教育工作者和执照颁发委员会利用多项选择题（MCQ）来评估这些知识和技能。编写MCQ基于两个假设：一是可以根据布鲁姆分类法将其编写为高阶或低阶问题，二是学生对问题的认知与预期的分类水平相同。本研究旨在通过分析学生对MCQ布鲁姆水平的认知差异与他们的知识和信心之间的关系，来了解学生对问题的处理方式。
共有137名学生回答了内分泌科的练习MCQ。参与者指出问题的答案、他们对问题是高阶还是低阶的解读，以及对问题答案的信心程度。
尽管学生在内容上的平均表现与他们对问题的分类（高阶或低阶）之间没有显著关联，但对答案信心较低的个体学生将问题识别为高阶的可能性是其更有信心的同伴的五倍多（OR = 5.49）。MCQ回答错误的学生将问题识别为高阶的可能性是回答正确的同伴的四倍。
结果表明，表现更好、更有信心的学生依赖于识别模式（即使问题原本是高阶的）。相比之下，信心较低的学生即使问题原本是低阶的，也会进行高阶的分析性思维。更好地理解学生解释MCQ的过程将有助于我们更好地理解临床推理技能的发展。
