Strides in Development of Medical Education

Document Type : Original Article


1 Ph.D. in Nutritional Sciences, Assistant Professor, Department of Nutrition, Physiology Research Center, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran

2 General Practitioner, M.Sc. in Medical Education, Research Center for Health Services Management, Kerman University of Medical Sciences, Kerman, Iran


  Background & Objective: The present study aimed to compare the students ability in answering to patient management problem (PMP) and modified essay question (MEQ) examination with multiplechoice question (MCQ) examination and its association with educational promotion   Methods: This research carried out in two sections descriptiveanalytic and qualitative on 76 nutrition students of Kerman University of Medical Sciences Iran who were selected by census The first and second examinations were PMPMEQ and MCQ respectively Educational promotion variables were grade point average (GPA) in 5 sequence semesters and GPA in current semester The other variables were the grade in food toxicology course the scores in PMPMEQ PMP and MEQ exams and MCQ exam The second section was designed with the aim of comparing the overview of students in regard to PMPMEQ and MCQ exams Data were analyzed by descriptive and analytic statistics   Results: The association between educational promotion variables and mark of food toxicology course and MCQ exam were statistically significant (P < 0001) however there was not a statistically significant association between these variables and the other variables Mean differences scores of MCQ and food toxicology course were significant (P < 0001) however scores of PMPMEQ test and PMP and MEQ sections in two students groups based on categorized GPA were not statistically significant   Conclusion: Therefore the students inability in answering to PMP and MEQ examination in comparing to the MCQ examination format was showed students incapability in evaluation of clinical competence even with regard to their high GPA and scientific knowledge


  1. Van der Vleuten C, Newble DI. How can we test clinical reasoning? The Lancet 1995; 345(8956): 1032-34.
  2. Feletti GI, Saunders NA, Smith AJ. Comprehensive assessment of final year medical student performance based on undergraduate program objectives. The Lancet 1983; 322(8340): 34-7.
  3. Harden RM. Preparation and presentation of patient-management problems (PMPs). Med Educ 1983; 17(4): 255-76.
  4. Newble DI. Assessing clinical competence at the undergraduate level. Med Educ 1992; 26(6): 503-11.
  5. Marquis Y, Chaoulli J, Bordage G, Chabot JM, Leclere H. Patient-management problems as a learning tool for the continuing medical education of general practitioners. Med Educ 1984; 18(2): 117-24.
  6. Farmer EA, Page G. A practical guide to assessing clinical decision-making skills using the key features approach. Med Educ 2005; 39(12): 1188-94.
  7. Irwin WG, Bamber JH. The cognitive structure of the modified essay question. Med Educ 1982; 16(6): 326-31.
  8. Schubert S, Schnabel KP, & Winkelmann A. Assessment of spatial anatomical knowledge with a 'three-dimensional multiple choice test' (3D-MC). Med Teach 2009; 31(1): e13-7.
  9. Hammond EJ, McIndoe AK, Sansome AJ, Spargo PM. Multiple-choice examinations: adopting an evidence-based approach to exam technique. Anaesthesia 1998; 53(11): 1105-8.
  10. Southwick F, Katona P, Kauffman C, Monroe S, Pirofski LA, Del Rio C., et al. Commentary: IDSA guidelines for improving the teaching of preclinical medical microbiology and infectious diseases. Acad Med 2010; 85(1): 19- 22.
  11. Shayan SH. Using patient management problem (EPMP) in assessment of clinical competency. Iran J Med Educ 2011; 10(5): 1087-92. [In Persian]
  12. Sood R, SINGH T. Assessment in medical education: Evolving perspectives and contemporary trends. Natl Med J India 2012; 25(6):357 – 64.
  13. Fitzgerald JT, Gruppen LD, White CB. The influence of task formats on the accuracy of medical students' self-assessments. Acad Med 2000; 75(7): 737-41.
  14. Wilkinson TJ, Frampton CM. Comprehensive undergraduate medical assessments improve prediction of clinical performance. Med Educ 2004; 38(10): 1111-6.
  15. Gijbels D, Dochy F, Van den Bossche P, Segers M. Effects of problem-based learning: A meta-analysis from the angle of assessment. Rev Educ Res 2005;75(1): 27-61.
  16. Rassaian N, Nakhaei S, Sadeghi Ghandehari N. Comparison of three exam techniques in medical students: Multiple-choice, true-false and short answer question. Hakim 2003; 5(4): 271-80. [In Persian]
  17. Wilkinson, TJ, Wade WB, Knock, LD. A Blueprint to Assess Professionalism: Results of a Systematic Review. Acad Med 2009; 84(5): 551- 8.
  18. Rethans JJ, Norcini J, Maldonado MB, Blackmore D, Jolly BC, LaDuca L, et al. The relationship between competence and performance: implications for assessing practice performance. Med Educ 2002;36(10): 901–9.