![]() JMIR Bioinformatics and Biotechnology 39 articles.JMIR Biomedical Engineering 81 articles.Journal of Participatory Medicine 87 articles.JMIR Perioperative Medicine 105 articles.JMIR Rehabilitation and Assistive Technologies 243 articles.JMIR Pediatrics and Parenting 345 articles.Interactive Journal of Medical Research 361 articles.JMIR Public Health and Surveillance 1366 articles.Journal of Medical Internet Research 8291 articles.The authors propose that various factors affect both the question writer and examinee's interaction with test material and subsequent cognitive processes necessary to answer a question. In this Perspective, the authors describe some of the cognitive processes examinees use to respond to MCQs. Likewise, seemingly lower-order questions may actually require higher-order thinking skills to respond correctly. Consequently, faculty question writers may perceive that certain MCQs require higher-order thinking skills to process the question, whereas examinees may only need to employ lower-order thinking skills to render a correct response. Faculty question writers and examinees may approach the same material differently based on varying levels of knowledge and expertise, and these differences can influence the cognitive levels being measured by MCQs. Similarly, clinical practice also requires learners to develop higher-order thinking skills that include all of Bloom's levels. Bloom's taxonomy has been used to identify MCQs that assess students' critical thinking skills, with evidence suggesting that higher-order MCQs support a deeper conceptual understanding of scientific process skills. Multiple-choice questions (MCQs) are commonly used to assess student learning, and well-written MCQs can support learner engagement in higher levels of cognitive reasoning such as application or synthesis of knowledge. Medical school assessments should foster the development of higher-order thinking skills to support clinical reasoning and a solid foundation of knowledge. Santen is assistant dean for educational research and quality improvement, Office of Medical Student Education, and associate professor and chair of education, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan. Gruppen is professor, Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan. Ahmed is assistant professor of internal medicine, University of Michigan Medical School, Ann Arbor, Michigan. Tai is assistant professor of internal medicine and of microbiology and immunology, University of Michigan Medical School, Ann Arbor, Michigan. Kurtz is a second-year medical student, University of Michigan Medical School, Ann Arbor, Michigan. Monrad is science and clinical trunk director, Office of Medical Student Education, and clinical associate professor of internal medicine and learning health sciences, University of Michigan Medical School, Ann Arbor, Michigan. Grob is assistant director of evaluation and assessment, Office of Medical Student Education, University of Michigan Medical School, Ann Arbor, Michigan. Zaidi is associate director of evaluation and assessment, Office of Medical Student Education, University of Michigan Medical School, Ann Arbor, Michigan.
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