The VSAQ format demonstrated high reliability and discrimination and items were perceived as more authentic. The SBAQ format was associated with significant cueing. The present results suggest the VSAQ format has a higher degree of validity.

BackgroundSingle Best Answer (SBA) questions are widely used in undergraduate and postgraduate medical examinations. Selection of the correct answer in SBA questions may be subject to cueing and therefore might not test the student’s knowledge. In contrast to this artificial construct, doctors are ultimately required to perform in a real-life setting that does not offer a list of choices. This professional competence can be tested using Short Answer Questions (SAQs), where the student writes the correct answer without prompting from the question. However, SAQs cannot easily be machine marked and are therefore not feasible as an instrument for testing a representative sample of the curriculum for a large number of candidates. We hypothesised that a novel assessment instrument consisting of very short answer (VSA) questions is a superior test of knowledge than assessment by SBA.MethodsWe conducted a prospective pilot study on one cohort of 266 medical students sitting a formative examination. All students were assessed by both a novel assessment instrument consisting of VSAs and by SBA questions. Both instruments tested the same knowledge base. Using the filter function of Microsoft Excel, the range of answers provided for each VSA question was reviewed and correct answers accepted in less than two minutes. Examination results were compared between the two methods of assessment.ResultsStudents scored more highly in all fifteen SBA questions than in the VSA question format, despite both examinations requiring the same knowledge base.ConclusionsValid assessment of undergraduate and postgraduate knowledge can be improved by the use of VSA questions. Such an approach will test nascent physician ability rather than ability to pass exams.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0793-z) contains supplementary material, which is available to authorized users.

Uncertainty is a common and increasingly acknowledged problem in clinical practice. Current single best answer (SBA) style assessments test areas where there is one correct answer, and as the approach to assessment impacts on the approach to learning, these exams may poorly prepare our future doctors to handle uncertainty. We therefore need to modify our approach to assessment to emphasize reasoning and introduce the possibility of more than one 'correct' answer. We have developed clinical prioritisation questions (CPQs), a novel formative assessment tool in which students prioritise possible responses in order of likelihood. This assessment format was piloted with a group of medical students and evaluated in comparison with the more traditional single SBA question format in a team-based learning setting. Students reported that they felt ongoing use would help improve their tolerance of uncertainty (p<0.01). Furthermore, over 80% of students felt that CPQs were more reflective of real-life clinical practice. Group based discussions were significantly longer when answering CPQs (p<0.01), suggesting they may promote richer discourse. CPQs may have a role in formative assessment to help equip students with the skills to cope with ambiguity and strengthen clinical reasoning and decision-making. Institutions may find them more practical to implement compared with other clinical reasoning assessment tools.

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This article presents a vivid account of one woman's experience of taking on a second job -the role of a slimming club consultant -when her husband is made unemployed. Her story highlights how aesthetic labour, particularly when a worker's appearance becomes more prominent over time, can lead to dangerous behaviours, namely the use of weight-loss pills and illegal drugs. These behaviours resulted in sleeplessness, frequent headaches and a feeling of disgust. Furthermore, this troubling account raises an important and uncomfortable question: can discrimination in the workplace sometimes be 'for the best'?