Haycocks Neil G, Hernandez-Moreno Jessica, Bester Johan C, Hernandez Robert, Kalili Rosalie, Samrao Daman, Simanton Edward, Vida Thomas A
Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA.
Utah Office of the Medical Examiner, Taylorsville, UT, USA.
Adv Med Educ Pract. 2024 Dec 14;15:1217-1228. doi: 10.2147/AMEP.S478193. eCollection 2024.
Multiple choice questions (MCQs) are the mainstay in examinations for medical education, physician licensing, and board certification. Traditionally, MCQs tend to test rote recall of memorized facts. Their utility in assessing higher cognitive functions has been more problematic to determine. This work evaluates and compares the difficulty and long-term retention of factual versus conceptual knowledge using multiple-choice questions in a longitudinal study.
We classified a series of MCQs into two groups to test recall/verbatim and conceptual/inferential thinking, respectively. We used the MCQs to test a two-part hypothesis: 1) scores for recall/verbatim questions would be significantly higher than for concept/inference questions, and 2) memory loss over time would be more significant for factual knowledge than conceptual understanding compared with a loss in the ability to reason about concepts critically. We first used the MCQs with pre-clinical medical students on a summative exam in 2020, which served as a retrospective benchmark of their performance characteristics. After two years, the same questions were re-administered to volunteers from the same cohort of students in 2020.
Retrospective analysis revealed that recall/verbatim questions were answered correctly more frequently (82.0% vs 60.9%, P = 0.002). Performance on concept/inference questions showed a significant decline, but a larger decline was observed for recall/verbatim questions after two years. Performance on concept/inference questions showed a slight decline across quartiles, while two years later, recall/verbatim questions experienced substantial performance loss. Subgroup analysis indicated convergence in performance on both question types, suggesting that the clinical relevance of the MCQ content may have influenced a regression toward a baseline mean.
These findings suggest conceptual/inferential thinking is more complex than rote memorization. However, the knowledge acquired is more durable in a longitudinal fashion, especially if it is reinforced in clinical settings.
多项选择题（MCQs）是医学教育、医师执照考试和委员会认证考试的主要形式。传统上，多项选择题倾向于测试对记忆事实的死记硬背。其在评估更高认知功能方面的效用更难确定。这项研究在一项纵向研究中使用多项选择题评估并比较了事实性知识与概念性知识的难度及长期记忆情况。
我们将一系列多项选择题分为两组，分别测试记忆/逐字回忆和概念/推理思维。我们使用这些多项选择题来检验一个分为两部分的假设：1）记忆/逐字回忆问题的得分将显著高于概念/推理问题的得分；2）与批判性推理概念的能力丧失相比，随着时间的推移，事实性知识的记忆丧失将比概念性理解更显著。我们首先在2020年的一次总结性考试中让临床前医学生使用这些多项选择题，这作为他们表现特征的回顾性基准。两年后，对来自2020年同一批学生中的志愿者重新使用相同的问题进行测试。
回顾性分析显示，记忆/逐字回忆问题的回答正确率更高（82.0%对60.9%，P = 0.002）。概念/推理问题的表现有显著下降，但两年后记忆/逐字回忆问题的下降幅度更大。概念/推理问题的表现在四分位数之间略有下降，而两年后，记忆/逐字回忆问题的表现大幅下降。亚组分析表明两种题型的表现趋于一致，这表明多项选择题内容的临床相关性可能影响了向基线均值的回归。
这些发现表明概念/推理思维比死记硬背更复杂。然而，所获得的知识在纵向方面更持久，特别是如果在临床环境中得到强化。
