Twelve tips for assessing medical knowledge with open-ended questions: Designing constructed response examinations in medical education

Abstract

Medical knowledge examinations employing open-ended (constructed response) items can be useful to assess medical students’ factual and conceptual understanding. Modern day curricula that emphasize active learning in small groups and other interactive formats lend themselves to an assessment format that prompts students to share conceptual understanding, explain, and elaborate. The open-ended question examination format can provide faculty with insights into learners’ abilities to apply information to clinical or scientific problems, and reveal learners’ misunderstandings about essential content. To implement formative or summative assessments with open-ended questions in a rigorous manner, educators must design systems for exam creation and scoring. This includes systems for constructing exam blueprints, items and scoring rubrics, and procedures for scoring and standard setting. Information gained through review of students’ responses can guide future educational sessions and curricular changes in a cycle of continuous improvement.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Additional information

Notes on contributors

Karen E. Hauer

Karen E. Hauer, MD, PhD, is Associate Dean of Competency Assessment and Professional Standards and Professor of Medicine in the School of Medicine at University of California, San Francisco.

Christy Boscardin

Christy Boscardin, PhD, is Associate Professor of Medicine in the School of Medicine at University of California, San Francisco.

Judith M. Brenner

Judith M. Brenner, MD, is Associate Dean of Curricular Integration and Assessment at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.

Sandrijn M. van Schaik

Sandrijn M. van Schaik, MD, PhD, is Baum Presidential Chair for Experiential Learning and Professor of Pediatrics in the School of Medicine at University of California, San Francisco.

Klara K. Papp

Klara K. Papp, PhD, is Director of Student Assessment and Program Evaluation and Professor at Case Western Reserve University School of Medicine.