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Multiple Choice Questions

Multiple Choice Questions (MCQs) should be banned. Or, Should they?

Medical specialties across the globe have a special affinity towards Multiple Choice Questions, the so called MCQs. This tendency is no doubt based on scientific evidence that strongly suggests that MCQs are standards of objectivity and reliability.

The multiple choice question (MCQ) is the most common type of written test item used in undergraduate, graduate and post-graduate medical education. However, the rampant use of MCQs does not make it the most appealing one. And, undoubtedly, there is always mixed feelings about multiple choice questions among the examinees. I am not sure about you or the examiner though, but I strongly protested against MCQs in my early days in Medical Education.

Indian post-graduate entrance exams have a long and faithful relationship with the multiple choice question format, and All India Post-Graduate Medical Entrance Exam(AIPGMEE), the standard in medical entrance exams in India also follows the same pattern.

I can swear that at least 80 percent of those facing these examinations dread them, if not despise them. Most of us think MCQs should be banned! Let us see what I think about MCQs.

The Case for MCQs

What makes the MCQ formidable when it comes to evaluating medical professionals?

The flexibility, uniformity and ease of evaluation makes it a ready choice for examiners. MCQs can assess a broad range of learner knowledge in a short period of time. Because a large number of questions can be developed for a given content area, which provides a broad coverage of concepts that can be tested consistently, the MCQ format allows for test reliability.

MCQs drawn from a representative sample of content areas that constitute pre-determined learning outcomes, they allow for a higher degree of test validity. Appropriately constructed MCQs result in objective testing that can measure knowledge, comprehension, application and analysis.

MCQs can be evaluated according to their reliablility, validity, and resource intensiveness. Reliablility provides a measure of an item’s generalizability. Items in a test represent a small sample of all the possible MCQs that could be asked, and the test score should be indicative of the score of the same student on any other set of relevant items. Validity refers to the extent that a test measures what it claims to measure.

Resource-intensiveness is determined by the costs of constructing and grading items. MCQs are relatively easy to grade, especially with computer assistance, but are difficult and time-consuming to construct.

Critique against MCQs

Most of us that are critical about MCQs, the belief is that they cannot be used to test higher level learning. The disadvantages that make the critics happy are that they test recognition (choosing an answer) rather than recall (constructing an answer), allow guesswork, and are difficult and time-consuming to construct.

The test of vague clinical syndromes in medical MCQs has kind of become a menace, and the enterprising examinee makes extra effort to learn rare syndromes, when he/she should be mastering the basics of medical practice. Clinical-based questions can be biased at times presenting confusing options to the examinee, if framed incorrectly.

The Verdict on MCQs: Should MCQs be banned?

My verdict on MCQs, without being biased, is an inclination towards it. MCQs are integral to effective evaluation of medical professionals. I was once a staunch disbeliever in MCQs. The benefits and relative ease of evaluation surely leaves no room for error, other than that by the examiner.

The highly efficient electronic machines that do the corrections are almost flawless in evaluating the papers. MCQs can be evaluated according to their reliablility, validity, and resource intensiveness. Reliablility provides a measure of an item’s generalizability. Items in a test represent a small sample of all the possible MCQs that could be asked, and the test score should be indicative of the score of the same student on any other set of relevant items.

Validity refers to the extent that a test measures what it claims to measure. Resource-intensiveness is determined by the costs of constructing and grading items. MCQs are relatively easy to grade, especially with computer assistance, but are difficult and time-consuming to construct. However, objectivity and reliablility in assessing the cognitive domain is one of the benefits of utilizing MCQs.

Considering all the benefits of MCQs, I would choose MCQs any day, rather than be subject to the ire of an unknown examiner. My judgment is that Multiple Choice Questions (MCQs) should be the standard to avoid any bias in examining medical students, albeit without the extremely tough questions that only create a sense of insecurity among the examinees. I admit that MCQ format has its flaws, but the benefits surely outwit them. So, my support for its implementation in AIPGMEE 2013 stands, and banning MCQs is out of the question.

These are my thoughts about MCQs. What do you think? What is the consensus?

• Meet the Author • Dr. Lawrence Kindo


I am a Medical Professional with a passion for writing, blogging, playing, computers, and of course patient care. My writing in this medical blog will reflect my passion, and you are welcome to be a part of this venture. This medical blog is a tribute to all the great medical pioneers, and to the ultimate source of wisdom, God.


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