Purpose It is assumed that case-based questions require higher-order cognitive processing, whereas questions that are not case-based require lower-order cognitive processing. In this study, we investigated to what extent case-based and non-case-based questions followed this assumption based on Bloom’s taxonomy.
Methods In this article, 4,800 questions from the Interuniversity Progress Test of Medicine were classified based on whether they were case-based and on the level of Bloom’s taxonomy that they involved. Lower-order questions require students to remember or/and have a basic understanding of knowledge. Higher-order questions require students to apply, analyze, or/and evaluate. The phi coefficient was calculated to investigate the relationship between whether questions were case-based and the required level of cognitive processing.
Results Our results demonstrated that 98.1% of case-based questions required higher-level cognitive processing. Of the non-case-based questions, 33.7% required higher-level cognitive processing. The phi coefficient demonstrated a significant, but moderate correlation between the presence of a patient case in a question and its required level of cognitive processing (phi coefficient= 0.55, P< 0.001).
Conclusion Medical instructors should be aware of the association between item format (case-based versus non-case-based) and the cognitive processes they elicit in order to meet the desired balance in a test, taking the learning objectives and the test difficulty into account.
Citations
Citations to this article as recorded by
To the Point: Substituting SOAP Notes for Vignettes in Preclinical Assessment Question Stems Kristina Lindquist, Derek Meeks, Kyle Mefferd, Cheryl Vanier, Terrence W. Miller Medical Science Educator.2025;[Epub] CrossRef
Progress is impossible without change: implementing automatic item generation in medical knowledge progress testing Filipe Manuel Vidal Falcão, Daniela S.M. Pereira, José Miguel Pêgo, Patrício Costa Education and Information Technologies.2024; 29(4): 4505. CrossRef
Reliability across content areas in progress tests assessing medical knowledge: a Brazilian cross-sectional study with implications for medical education assessments Pedro Tadao Hamamoto Filho, Miriam Hashimoto, Alba Regina de Abreu Lima, Leandro Arthur Diehl, Neide Tomimura Costa, Patrícia Moretti Rehder, Samira Yarak, Maria Cristina de Andrade, Maria de Lourdes Marmorato Botta Hafner, Zilda Maria Tosta Ribeiro, Júli Sao Paulo Medical Journal.2024;[Epub] CrossRef
Development of qualified items for nursing education assessment: The progress testing experience Bruna Moreno Dias, Lúcia Marta Giunta da Silva, Pedro Tadao Hamamoto Filho, Valdes Roberto Bollela, Carmen Silvia Gabriel Nurse Education in Practice.2024; 81: 104199. CrossRef
Identifying the response process validity of clinical vignette-type multiple choice questions: An eye-tracking study Francisco Carlos Specian Junior, Thiago Martins Santos, John Sandars, Eliana Martorano Amaral, Dario Cecilio-Fernandes Medical Teacher.2023; 45(8): 845. CrossRef
Relationship between medical programme progress test performance and surgical clinical attachment timing and performance Andy Wearn, Vanshay Bindra, Bradley Patten, Benjamin P. T. Loveday Medical Teacher.2023; 45(8): 877. CrossRef
Analysis of Orthopaedic In-Training Examination Trauma Questions: 2017 to 2021 Lilah Fones, Daryl C. Osbahr, Daniel E. Davis, Andrew M. Star, Atif K. Ahmed, Arjun Saxena JAAOS: Global Research and Reviews.2023;[Epub] CrossRef
Use of Sociodemographic Information in Clinical Vignettes of Multiple-Choice Questions for Preclinical Medical Students Kelly Carey-Ewend, Amir Feinberg, Alexis Flen, Clark Williamson, Carmen Gutierrez, Samuel Cykert, Gary L. Beck Dallaghan, Kurt O. Gilliland Medical Science Educator.2023; 33(3): 659. CrossRef
What faculty write versus what students see? Perspectives on multiple-choice questions using Bloom’s taxonomy Seetha U. Monrad, Nikki L. Bibler Zaidi, Karri L. Grob, Joshua B. Kurtz, Andrew W. Tai, Michael Hortsch, Larry D. Gruppen, Sally A. Santen Medical Teacher.2021; 43(5): 575. CrossRef
Aménagement du concours de première année commune aux études de santé (PACES) : entre justice sociale et éthique confraternelle en devenir ? R. Pougnet, L. Pougnet Éthique & Santé.2020; 17(4): 250. CrossRef
Knowledge of dental faculty in gulf cooperation council states of multiple-choice questions’ item writing flaws Mawlood Kowash, Hazza Alhobeira, Iyad Hussein, Manal Al Halabi, Saif Khan Medical Education Online.2020;[Epub] CrossRef