Progressive clinical case-based multiple-choice questions: An innovative way to evaluate and rank undergraduate medical students

F Cohen Aubart; R Lhote; A Hertig; N Noel; N Costedoat-Chalumeau; A Cariou; G Meyer; F Cymbalista; N de Prost; P Pottier; L Joly; O Lambotte; M-C Renaud; C Badoual; M Braun; O Palombi; A Duguet; D Roux

doi:10.1016/j.revmed.2020.11.006

Progressive clinical case-based multiple-choice questions: An innovative way to evaluate and rank undergraduate medical students

Rev Med Interne. 2021 May;42(5):302-309. doi: 10.1016/j.revmed.2020.11.006. Epub 2021 Jan 29.

Authors

F Cohen Aubart¹, R Lhote², A Hertig³, N Noel⁴, N Costedoat-Chalumeau⁵, A Cariou⁶, G Meyer⁷, F Cymbalista⁸, N de Prost⁹, P Pottier¹⁰, L Joly¹¹, O Lambotte⁴, M-C Renaud¹², C Badoual¹³, M Braun¹⁴, O Palombi¹⁵, A Duguet¹⁶, D Roux¹⁷

Affiliations

¹ Service de médecine interne 2, hôpital Pitié-Salpêtrière, centre national de référence maladies systémiques rares et histiocytoses, Sorbonne université, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France. Electronic address: fleur.cohen@aphp.fr.
² Service de médecine interne 2, hôpital Pitié-Salpêtrière, centre national de référence maladies systémiques rares et histiocytoses, Sorbonne université, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
³ Service de transplantation rénale, hôpital Pitié-Salpêtrière, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75013 Paris, France.
⁴ Service de médecine interne, hôpital du Kremlin-Bicêtre, Assistance publique-Hôpitaux de Paris, 94250 Le Kremlin Bicêtre, France.
⁵ Département de médecine interne, hôpital Cochin, Assistance publique-Hôpitaux de Paris, centre de référence maladies autoimmunes et systémiques rares, université de Paris, Cress, Inserm, INRA, 75014 Paris, France.
⁶ Service de médecine intensive et réanimation, hôpital Cochin, Assistance publique-Hôpitaux de Paris, centre-université de Paris, 75014 Paris, France.
⁷ Service de pneumologie, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 75015 Paris, France.
⁸ Service d'hématologie, hôpital Avicenne, Assistance publique-Hôpitaux de Paris, 93000 Bobigny, France.
⁹ Service de réanimation médicale, hôpitaux universitaires Henri-Mondor, Assistance publique-Hôpitaux de Paris, groupe de recherche clinique CARMAS, université Paris Est-Créteil, 94000 Créteil, France.
¹⁰ Service de médecine interne, CHU de Nantes, université de Nantes, site Hôtel Dieu, 44000 Nantes, France.
¹¹ Service de gériatrie, hôpitaux de Brabois, université de Lorraine, CHRU de Nancy, 54500 Vandoeuvre Les Nancy, France.
¹² Faculté de médecine, Sorbonne université, 75013 Paris, France.
¹³ Service d'anatomopathologie, hôpital européen Georges-Pompidou, université de Paris, 75015 Paris, France.
¹⁴ Service de neuroradiologie, CHRU de Nancy, université de Lorraine, 54500 Nancy, France.
¹⁵ Service de neurochirurgie, CHU de Grenoble, université Grenoble Alpes, 38000 Grenoble, France.
¹⁶ Service de pneumologie, hôpital Pitié-Salpêtrière, Sorbonne université, Assistance publique-Hôpitaux de Paris, 75013 Paris, France.
¹⁷ Service de médecine intensive réanimation, hôpital Louis-Mourier, université de Paris, Assistance publique-Hôpitaux de Paris, 92700 Colombes, France; Inserm, IAME, UMR-1137, 75018 Paris, France.

PMID: 33518414
DOI: 10.1016/j.revmed.2020.11.006

Abstract

Introduction: In France, at the end of the sixth year of medical studies, students take a national ranking examination including progressive clinical case-based multiple-choice questions (MCQs). We aimed to evaluate the ability of these MCQs for testing higher-order thinking more than knowledge recall, and to identify their characteristics associated with success and discrimination.

Methods: We analysed the 72 progressive clinical cases taken by the students in the years 2016-2019, through an online platform.

Results: A total of 72 progressive clinical cases (18 for each of the 4 studied years), corresponding to 1059 questions, were analysed. Most of the clinical cases (n=43, 60%) had 15 questions. Clinical questions represented 89% of all questions, whereas basic sciences questions accounted for 9%. The most frequent medical subspecialties were internal medicine (n=90, 8%) and infectious diseases (n=88, 8%). The most frequent question types concerned therapeutics (26%), exams (19%), diagnosis (14%), and semiology (13%). Level 2 questions ("understand and apply") accounted for 59% of all questions according to the Bloom's taxonomy. The level of Bloom's taxonomy significantly changed over time with a decreasing number of level 1 questions ("remember") (P=0.04). We also analysed the results of the students among 853 questions of training ECNi. Success and discrimination significantly decreased when the number of correct answers increased (P<0.0001 both). The success, discrimination, mean score, and mean number of discrepancies did not differ according to the diagnosis, exam, imaging, semiology, or therapeutic type of questions.

Conclusion: Progressive clinical case-based MCQs represent an innovative way to evaluate undergraduate students.

Keywords: Discrimination; Docimologie; Docimology; Dossiers progressifs; Evaluation; Multiple-choice questions; Progressive clinical cases; Questions à réponses multiples; Évaluation.

MeSH terms

Educational Measurement
France / epidemiology
Humans
Students, Medical*