Summary: In his latest blog Professor Harden addresses the question of Multiple Choice Questionnaires, the recent disaster in the Caribbean and competency-based education. Description: MCQs – Yes or no?
Having experience using both MCQs and very short answer questions, I have no doubt that the latter provides a better test of a candidate’s abilities. Who would I rather have treat me – a doctor who had scored high on an MCQ examination or a doctor who had scored high on a very short answer question paper? I have no doubt the answer is the latter. Surry and colleagues (2017) tested the authenticity of MCQs. While they did provide evidence that test takers’ descriptions of their cognitive processes during completion of high-quality clinical vignette MCQs align with processes expected in real world clinical reasoning, they also produced evidence that the presence of test taking behaviours argue against authenticity of the MCQ items,

                “many of the clue-seeking behaviours, as identified in some of the excerpts above, were taking advantage of the test in a manner inauthentic to real-world clinical practice. Guessing and process of elimination might also be viewed as being particularly inauthentic. After all, patients do not walk into the clinic saying ‘I have one of these five diagnoses. Which do you think is most likely?”

In their chapter on written assessments in the newly published fifth edition of A Practical Guide for Medical Teachers, Schuwirth and van der Vleuten suggest that very short answer questions rather than multiple choice questions should be used when spontaneous generation of the answer is essential or when the number of realistic options is too large.

The continued use and defence of MCQs is one aspect of medical education practice that puzzles me.

Surry, L.T., Torre, D. & Durning, S.J. 2017. Exploring examinee behaviours as validity evidence for multiple-choice question examinations. Medical Education. 51. 1075-85.

The Caribbean to the UK
In the recent weather catastrophe in the Caribbean almost all of St Maarten was destroyed including the American University of the Caribbean (AUC) medical school, with the exception of one shelter building designed to withstand a hurricane (which it did). How the students and staff coped with the disaster was impressive. After evacuation from the Caribbean and temporary accommodation in Chicago, 690 (almost all of the students) chose to transfer to the University of Central Lancashire (UCLAN) in the UK which offered them accommodation and facilities. Amazingly the arrangements and the students’ transfer from USA to UK was achieved in nine days! When I visited Preston last week, as a member of the AUC Board, teaching was already underway. The situation was proving an opportunity to rethink their teaching approaches.

Some more senior AUC students were already in the UK for their clinical attachments and I attended a symposium in Romford where four groups of students from different hospitals in the UK gave very polished and well thought out presentations relating to cases they had seen. These were interesting application of basic sciences to clinical medicine. For obvious reasons, two of the groups had chosen unusual and rare conditions to present. You see the same often at Grand Rounds where what are presented are the more atypical and unusual clinical presentations. One group, however, described five cases which illustrated the five senses in clinical examination – smell, touch, vision, taste and sound. Very interesting and imaginative.

Competency-based education
The June issue of Medical Teacher had as its theme Competency-Based Medical Education. I was impressed by the number of downloads, of the papers published. Since the articles were published in June, the number of downloads per-article has ranged from 455 to 975. The 975 downloads were for an article on the core principles of assessment in competency-based medical education.

I gave a webinar earlier in the month, as part of the ICBME webinar series on competency-based medical education – Common Myths in CBE. More than 250 participated. There was not time to deal with all of the 92 questions raised by those taking part. Some interesting issues were raised and I will write a short paper for MedEdPublish addressing the questions. This would allow further discussion.

New visitors from Thailand
We had a visit in Dundee and in the AMEE office from representatives of a relatively new medical school in Thailand. The photograph is of me with Dr Vichai Tienthavorn who is Vice President of the University of Phayao and Dean of the School of Medicine. Thailand is one of the countries which is best represented at the AMEE Conferences, with usually more than 300 participants at AMEE 2017 in Helsinki.