A case for written examinations in undergraduate medical education: experiences with modified essay examinations

Abstract

A modified essay is an open-ended question about clinical presentations, with the goal to test application of basic science principles to novel scenarios. Due to high reliability and validity, multiple-choice question (MCQ) examinations are more commonly used. We have employed a combination of MCQ and modified essay examinations in medical school. The correlation between MCQ and modified essay grades is positive but small, suggesting they may be testing different cognitive levels/skills. In this paper, we evaluate the impact of a non-graded mock modified essay on student’s performance and satisfaction, and outline our best practices. We have found that it is important to involve faculty from multiple disciplines to construct robust cases, and to review examinations and rubrics. The mock modified essay resulted in higher performance and student satisfaction, and fewer students’ comments related to subjectivity, frustration and anxiety. Yet, there was not an improvement in confidence. Moreover, there was no correlation between grades in the mock and graded modified essays, suggesting that the mock modified essay may not be useful to predict academic performance. Yet, the incorporation of a mock modified essay was useful to clarify expectations and provide guidance, potentially reducing the anxiety induced by an unfamiliar assessment.

Keywords:

• Modified essay examinations
• formative assessment
• open-ended questions
• integration

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Jenny Fortun

Dr. Jenny Fortun is an Associate Professor in the Cellular Biology and Pharmacology. She has a PhD in Biomedical Sciences from University of Florida, United States. She is involved in the teaching of biochemistry, physiology and immunology across the undergraduate medical curriculum. She is the Assistant Dean for foundational science curriculum.

Drs. Tempest and Fortun are course directors for multiple foundational science courses across the medical school curriculum including ‘Genes, molecules and cells’, the course this study is based on.

Helen Tempest

Dr. Helen Tempest is an Associate Professor in the Department of Human and Molecular Genetics. She has a PhD in Genetics from Brunel University, United Kingdom. She is involved in the teaching of genetics across the undergraduate medical curriculum.

Drs. Tempest and Fortun are course directors for multiple foundational science courses across the medical school curriculum including ‘Genes, molecules and cells’, the course this study is based on.