PGY-1 Pharmacy Resident
University of Maryland Baltimore Washington Medical Center
During a pharmacist’s first year of pharmacy education there are a plethora of classes embedded into the curriculum to prepare students for the vast amount of clinical information that is to be mastered in the proceeding semesters. One such class at the University of Maryland School of Pharmacy is “Professional Foundations of Pharmacy”. While attending one of the first lectures of this course a clinical faculty member ended his lecture by imploring to the students this message: “The information that you learn over the next four years is going to prepare you for the rest of your life, please don’t make the mistake of cramming and dumping information to get good grades on exams. Good grades are not going to benefit you while you’re out in clinical practice, but truly understanding and learning the material as you progress over the next few years will make you a strong and independent pharmacist.” Although this message was given to me during one of my very first lectures of pharmacy school it resonates with me to this day because it was genuine, truthful, and encapsulates the meaning of pharmacy school, to become a strong and independent thinking pharmacist. I pose a question to you: If the goal of pharmacy school is to become a strong and independent thinker shouldn’t assessments during pharmacy school facilitate this goal?
Historically both teaching and assessment in pharmacy education comes in the context of limited resources. As a consequence assessments are typically in the format of multiple choice (MC) exams because they can be graded using a key which allows for rapid grading. However, there are many short comings in assessing a student’s mastery of material using this testing style.1 First, MC exams are prone to test taking strategies such as option elimination. Therefore students who develop good testing strategies may simply be narrowing down what they believe is the most correct answer by eliminating answers they know are wrong. While this is beneficial for licensure exams this is not going to be useful in clinical practice when as a pharmacist they need to make a therapy management decision based on recall. Second, the format of MC exams creates a learning environment where a student must be able to simply identify a correct answer rather than be able to justify answers and demonstrate a complex understanding of a topic. This type of environment facilitates learning that revolves around studying for a test rather than studying to understand. Third, MC exams do not assess a student’s complete understanding of a topic.1 This phenomenon is demonstrated in a study completed by couch et al.1 where they assessed student knowledge of chemical reaction dynamics using both MC and multiple-true-false (MTF) questions. When using a MC exam 95% of students demonstrated mastery of the concept, however, when assessed using MTF format only 49% of students demonstrated complete mastery of the concept. This finding shows that MC exams overestimate student comprehension because when asked about the same topic with a different question format only half of the students were able to fully answer the question.
To better facilitate learning in pharmacy education I propose using MTF exams.1 There are multiple benefits of a MTF assessment. First, this style of still allows for effortless rapid grading which is the main appeal of MC exams. Second, MTF assessments promote appropriate studying habits.2 MTF assessments require more than simply identifying one single correct answer on an exam. Therefore, in order to do well on the exam students will require a complex understanding of information which facilitates robust study habits. Third, MTF assessments are shown to benefit lower performing students at risk for failing a course. MTF exams benefit lower performing students by using a partial credit scoring system. On a traditional MC exam questions are graded in absolutes where the student either gets full points or gets no points. However, MTF assessments allow for a partial credit scoring system where students can still gain points even if the topic is not completely mastered. Lastly, MTF exams are better able to depict a student’s partial understanding of a topic. Each question on a MTF exam can specifically be linked to a course learning objective and provide diagnostic information on a learner’s understanding as well as the lecturers ability to portray information in a way that ensures students are reaching learning outcomes.
Due to the diagnostic capabilities of a MTF exam format the implementation into practice is not only beneficial to the student, but also the lecturer. Through analysis of the classes’ performance on individual questions and then subsections of each question the lecturer will have precise data on exactly where student comprehension is lacking. This information in beneficial in two separate ways. First, this information can be used to provide feedback or fill in knowledge gaps after exams. This is extremely important in pharmacy education because ultimately the goal of pharmacy education should be to produce strong independent thinking pharmacists. Therefore, MTF exams provide lecturers a unique opportunity to continue strengthening a student’s knowledge even after the exam has been taken or in some cases after a course has ended. Additionally, the diagnostic information supplied from student performance on exams can serve as a tool to guide the instructor on how to improve their lecture for the upcoming year.
In summary, there are systemic flaws in the use of MC exams in pharmacy education. The MTF assessment style addresses the shortcomings of MC exams while providing benefits to both learners and lecturers.
References:
1. Brian A Couch, Joanna K Hubbard, Chad E Brassil, Multiple–True–False Questions Reveal the Limits of the Multiple–Choice Format for Detecting Students with Incomplete Understandings, BioScience, Volume 68, Issue 6, June 2018, Pages 455–463, https://doi.org/10.1093/biosci/biy037
2. Dyson B. Study Hacks: How to Ace Multiple Choice Exams. Pharmacy Times. https://www.pharmacytimes.com/view/study-hacks-how-to-ace-multiple-choice-exams. Published 2017. Accessed September 11, 2021.
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