From Multiple-Choice to Open-Ended

Emily Tiao, PharmD, PGY-1 Pharmacy Practice Resident

University of Maryland Medical Center

A frequently used modality of assessment is the classic multiple-choice question. This format poses a question and presents a selection of distractors and alternatives, but only one keyed response that qualifies as “correct.”¹ In an interesting parallel, it seems that many decisions from childhood up to higher education could be summarized as multiple-choice questions. Depending on the question, there could be many or few selections to choose from, but in the course of development from infant to collegiate, a relatively focused array of options exist - what classes to take, what sport to play, which colleges to attend. Students are trained to think in multiple-choice until, upon graduation, the questions suddenly become open-ended. The types of decisions that need to be made become far more complex and multifactorial, and require more than simply circling a letter - what career path to take, what city to live in - and the responsibility falls on the individual more heavily than ever before. And when the answer, or even possible answers, become more abstract, it exposes a mindset in which, at some point, the answer itself became more important than the reasoning leading up to finding it, demonstrating a need for students to develop critical thinking skills throughout their education.

Critical thinking skills have been noted as being deficient in students transitioning from college to the workplace. A study examining over 2300 undergraduates at universities found that students improved little in key areas, most notably in critical thinking. The 2010 Noel-Levitz Employer Satisfaction Survey polled employers who reinforced the sentiment that the skill new graduates most consistently lacked was in critical thinking.² In parallel, a study examining the progression of the critical reasoning skills pharmacy students possessed over time found that, although the baseline critical skill level was above reported averages, their development over one year was minimal.³ These findings support the observations of an article published in the Pharmacy Times titled “How to Transition from a Student to a Pharmacist”, which describes the stress and difficulties students face when progressing from a controlled, “multiple-choice” environment to one where the answers to patient care decisions become quite open-ended.⁴  In order to facilitate this transition, the mental shifts dial back to emphasis on developing a set of skills rather than simply arriving at the correct answer.

To develop critical thinking skills, the approach to the purpose of learning must emphasize how to analyze and process information, rather than simply knowing the right answer. Learners can benefit from dialing back to fundamentals of how to learn effectively – before learning what the right answer is, it is important to learn how to evaluate an issue, assess options, and form a solution. The subtle difference between these concepts parallels the saying “Give a man a fish, and you feed him for a day. Teach a man to fish, and you feed him for a lifetime.” An example comes from Fred Rogers, the creator and star of Mr. Rogers’ Neighborhood. Mr. Rogers’ approach to learning was summed up by one of his close colleagues – “Fred was more interested in helping children develop the “tools” they’ll need for success in school and in life: persistence, curiosity, getting along with others, self-control, and self-regulation.”⁵ Not only was the fundamental concept of Mr. Rogers’ teaching directed toward equipping children with the tools for problem solving, but also his execution of his messages. Mr. Rogers communicated, quite naturally, complex concepts in the context of social learning. Through examples that were relevant to current events at the time, Mr. Rogers demonstrated emotional and cognitive responses that modeled and conferred critical thinking methods, not just answers.

Fortunately, pharmacy education strives to prepare students to make complex decisions by employing models that encourage independent critical thinking. An educational model that helps facilitate the development of critical thinking skills is that of problem-based learning. The method of problem-based learning has been used in the education of multiple health professions, including nursing, dentistry, and pharmacy, and is founded on the concept that the process of independently figuring out the solution to a problem promotes the “acquisition of critical knowledge, problem-solving proficiency, self-directed learning strategies, and team participation skills”.⁶ A study conducted in 2005 at the University of Mississippi school of pharmacy examined its impact on student perception of preparedness for tackling the challenges of advanced practice experience rotations.⁶ This study found that, by employing the problem-based teaching model as its sole method in the third professional year, students reported feeling more capable of investigating, analyzing, and synthesizing information.

While the transition from pharmacy student to pharmacist can be difficult to navigate, it is comforting to know that the foundations for effective critical and analytical thinking have been laid by the didactic teaching received during formal education. Despite the uncertainty of the open-ended road ahead, it is liberating to view the potential choices ahead as a spectrum rather than as a limited selection.

References:

1.      Multiple Choice Questions Definition » Center for Innovative Learning. https://www.unthsc.edu/center-for-innovative-learning/multiple-choice-questions-definition/. Accessed September 8, 2018.

2.      Erickson S, Williams C, Braget M. 2010 UND Employer Satisfaction Survey.; 2011. http://www1.und.edu/research/institutional-research/_files/docs/surveys/ess-2010.pdf. Accessed September 8, 2018.

3.      Cisneros RM. Assessment of critical thinking in pharmacy students. Am J Pharm Educ. 2009;73(4):66. http://www.ncbi.nlm.nih.gov/pubmed/19657499. Accessed September 12, 2018.

4.      Dyson B. How to Transition from a Student to a Pharmacist. Pharmacy Times. https://www.pharmacytimes.com/contributor/brandon-dyson-pharmd-bcps/2017/02/how-to-transition-from-a-student-to-a-pharmacist. Published 2017. Accessed September 8, 2018.

5.      Sharapan H. What I Learned from Fred Rogers. http://www.fredrogerscenter.org/2013/03/what-i-learned-from-fred-rogers/. Published 2013. Accessed September 8, 2018.

6.      Hogan S, Lundquist LM. The Impact of Problem-Based Learning on Students’ Perceptions of Preparedness for Advanced Pharmacy Practice Experiences. https://www.ajpe.org/doi/pdf/10.5688/aj700482. Accessed September 9, 2018.