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FEM: Revista de la Fundación Educación Médica

On-line version ISSN 2014-9840Print version ISSN 2014-9832

FEM (Ed. impresa) vol.22 n.4 Barcelona Aug. 2019  Epub Oct 14, 2019



¿Ha pasado el tiempo de los exámenes de elección múltiple?

Are multiple-choice exams a thing of the past?

Are multiple-choice exams a thing of the past?

Jordi Palés-Argullós1 

1Fundación Educación Médica

The assessment of students and professionals in the health sciences has undoubtedly been one of the areas of medical education in which the most educational research has been conducted. Thus, on the basis of the evidence provided by that research, a number of assessment instruments have appeared at different times, each with its own indications, strengths and weaknesses.

One of the instruments that has always enjoyed and still enjoys great prestige is the multiple choice test, in which the examinee, faced with a question or a situation, must choose the right or the most appropriate answer among several options.

Multiple-choice tests were introduced in the early 20th century by Benjamin Wood (1894-1986), an educator, researcher and professor at Columbia University in the United States, who was a pioneer in automated learning technologies and assessment methods that were first applied in the intelligence tests conducted by the US military in World War I. He also contributed to the design of the first automated reader of the results of these tests.

In our country, as a medical student, I remember taking that kind of exam for the first time in the medical school back in the 1970s, and then using them in my teaching ever since. Today, we can say that it is an instrument that is widely used in educational centres.

This method of assessment arises from the need to evaluate a large number of candidates at the same time and with the highest possible degree of objectivity and reliability. It combines the advantages of its feasibility, since it is easy to administer and mark by means of automatic readers, and its reliability, provided that it is well designed. This is precisely where one of its weak points lies, since the rules are not always followed to produce these exercises in the most appropriate way.

Like any other assessment instrument, it has been criticised and has its weaknesses. In the field of health sciences, one of the criticisms made is that it does not evaluate in a sufficiently representative way the wide range of intellectual activities that health professionals are supposed to demonstrate. Other critics say that it has a limited role in the measurement of factual knowledge and capacity for application, although it is true that it can measure a broad spectrum of knowledge.

Despite these weaknesses, over the years it has become one of the most widely used assessment tools and a major component of numerous certification processes, and has been designed to provide evidence that an adequate level of competence has been achieved. However, in recent years, among experts in medical education voices have begun to emerge that this type of instrument should lose some of its importance to the benefit of others that might be more appropriate.

In this sense, in his last blog, Ronald Harden [1], under the suggestive heading ‘MCQs are dead’, advocates a substantial change with respect to the instruments we use in assessment. He endorses the statement by John Cookson, professor at Hull York Medical School, who argued at the end of a course organised by the Association for Medical Education in Europe (AMEE) that MCQ (multiple choice questions) have had their heyday and now other instruments should be used instead, especially the one known as VSAQ (very short answer questions).

Harden says the current evidence is clear: very short answer questions, in which the student answers with one, two or a very limited number of words rather than selecting an answer from a list of options as in a multiple choice test, offer great advantages. He considers that they are a more valid assessment tool and that they reflect the clinical decision process without the inherent indications of the multiple choice test because the professional, in his or her daily practice, is never offered a list of possible options from which to choose a diagnosis or treatment. In addition, the possibility of answering correctly simply by chance is eliminated. For this reason, Harden believes that very short answer questions are more challenging and provide better discrimination than the multiple choice test.

Recently, some original articles comparing the two assessment instruments concluded that very short answer questions show high reliability and a higher degree of discrimination and validity than multiple choice tests. In addition, the items are perceived by examinees as more authentic [2, 3].

However, the implementation of very short answer questions is not without its drawbacks, especially when it comes to correcting them, which could make them difficult to apply with a very large number of students.

In any case, in view of this evidence, it would perhaps be advisable for all of us who are involved in processes of assessing students and professionals in the health sciences to take this possibility into account and analyse the convenience and possibility of using this instrument in our teaching activities


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