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Pushing Critical Thinking Skills With Multiple-Choice Questions: Does Bloom’s Taxonomy Work?

Zaidi, Nikki L., Bibler, PhD; Grob, Karri, L., EdS; Monrad, Seetha, M., MD; Kurtz, Joshua, B.; Tai, Andrew, MD, PhD; Ahmed, Asra, Z., MD; Gruppen, Larry, D., PhD; Santen, Sally, A., MD, PhD

doi: 10.1097/ACM.0000000000002087
Perspectives
AM Rounds Blog Post

Medical school assessments should foster the development of higher-order thinking skills to support clinical reasoning and a solid foundation of knowledge. Multiple-choice questions (MCQs) are commonly used to assess student learning, and well-written MCQs can support learner engagement in higher levels of cognitive reasoning such as application or synthesis of knowledge. Bloom’s taxonomy has been used to identify MCQs that assess students’ critical thinking skills, with evidence suggesting that higher-order MCQs support a deeper conceptual understanding of scientific process skills. Similarly, clinical practice also requires learners to develop higher-order thinking skills that include all of Bloom’s levels. Faculty question writers and examinees may approach the same material differently based on varying levels of knowledge and expertise, and these differences can influence the cognitive levels being measured by MCQs. Consequently, faculty question writers may perceive that certain MCQs require higher-order thinking skills to process the question, whereas examinees may only need to employ lower-order thinking skills to render a correct response. Likewise, seemingly lower-order questions may actually require higher-order thinking skills to respond correctly. In this Perspective, the authors describe some of the cognitive processes examinees use to respond to MCQs. The authors propose that various factors affect both the question writer and examinee’s interaction with test material and subsequent cognitive processes necessary to answer a question.

N.L.B. Zaidi is associate director of evaluation and assessment, Office of Medical Student Education, University of Michigan Medical School, Ann Arbor, Michigan.

K.L. Grob is assistant director of evaluation and assessment, Office of Medical Student Education, University of Michigan Medical School, Ann Arbor, Michigan.

S.M. Monrad is science and clinical trunk director, Office of Medical Student Education, and clinical associate professor of internal medicine and learning health sciences, University of Michigan Medical School, Ann Arbor, Michigan.

J.B. Kurtz is a second-year medical student, University of Michigan Medical School, Ann Arbor, Michigan.

A. Tai is assistant professor of internal medicine and of microbiology and immunology, University of Michigan Medical School, Ann Arbor, Michigan.

A.Z. Ahmed is assistant professor of internal medicine, University of Michigan Medical School, Ann Arbor, Michigan.

L.D. Gruppen is professor, Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan.

S.A. Santen is assistant dean for educational research and quality improvement, Office of Medical Student Education, and associate professor and chair of education, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan.

An AM Rounds blog post on this article is available at academicmedicineblog.org.

Funding/Support: None reported.

Other disclosures: The University of Michigan Medical School has an Accelerating Change in Medical Education Grant from the American Medical Association.

Ethical approval: The authors received notice of exemption from the University of Michigan institutional review board on March 9, 2015 (HUM00098096).

Correspondence should be addressed to Nikki L. Bibler Zaidi, University of Michigan Medical School Office of Medical Student Education, 5310 Taubman Health Sciences Library, Ann Arbor, MI 48109-5726; telephone: (734) 615-3841; e-mail: bibler@med.umich.edu.

© 2018 by the Association of American Medical Colleges