ContExtended Questions (CEQ) to Teach and Assess Clinical Reasoning: A New Variant of F-Type Testlets

Abstract

This study introduces ContExtended Questions (CEQ), which is a tool both to teach and assess clinical reasoning particularly in the preclinical years, and the web-based program to implement. CEQ consists of text-based case-based multiple-choice questions that provide patient data in a fixed and predetermined sequence. It enables the examinees to develop and reshape their illness scripts by using feedback after every question. Feedback operates to transform the examinee’s failure into a “productive failure”. The preliminary results of the randomized controlled experiment of teaching clinical reasoning to preclinical students through CEQ is quite satisfactory. In the medical education literature, this would be the first time that students, who have no or very limited clinical experience, developed their illness scripts just by taking formative multiple-choice tests. The approach would be named “test-only learning”. The complete results of the experiment and then more experiments in other contexts and domains are necessary to establish a more powerful assessment tool and software. Furthermore, by changing the content of the questions, it is possible to use CEQ in every period of medical education and health professions education.

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“…The findings of the study have some implications. First, it supports the validity of F-type testlets 6 and CEQ 7,9,34 by providing evidence on consequences of assessment. Second, CEQ can be considered as one of the effective tools that can be used to improve vertical integration 35 in the preclinical years of undergraduate medical education if the curriculum is not well-integrated.…”

“…Third, the term “test-only learning” has been coined to distinguish “learning through only testing” from “testing as a support to other teaching methods”. It had been articulated in 2 previous studies 7,9 but this is the first time it is investigated and discussed particularly.…”

“…In the first day of the intervention, 88 volunteer Year-3 students showed up to participate in. These students accessed to an online tool called Con-tExtended Questions 7 to answer the questions nested in testlets and then receive the feedback related to the question. They answered 3 testlets each day by accessing the online tool from anywhere they have Internet connection and anytime within that day.…”

“…4 They may have different forms such as case presentations, interactive patient scenarios, games, high-fidelity simulations. 5 One of the tools that allow us to teach through interactive online cases is ContExtended Questions (CEQ), as a variant of F-type testlets, [6][7][8] that has been developed primarily for "assessment for learning" of clinical reasoning. 7,9 In CEQ, testlets provide patient information in a fixed sequence through text-based case scenarios with 5-15 weighted answer options.…”

“…5 One of the tools that allow us to teach through interactive online cases is ContExtended Questions (CEQ), as a variant of F-type testlets, [6][7][8] that has been developed primarily for "assessment for learning" of clinical reasoning. 7,9 In CEQ, testlets provide patient information in a fixed sequence through text-based case scenarios with 5-15 weighted answer options. Students can select multiple answers and receive predetermined feedback, including option scores and expert comments.…”