Assessment of medical knowledge: The pros and cons of using true/false multiple choice questions.

True/false multiple choice items, commonly referred to as true/ false multiple choice questions (MCQs), were previously a widely used selected response examination format. They can be written relatively easily and cover a wide range of content. Educational researchers have however highlighted several adverse features of this format that make it inappropriate for many assessment settings. These include: (i) there is a high chance of guessing the correct answer; (ii) some marks are not awarded for knowing the correct answer, but for knowing that an answer is incorrect; (iii) they are weak in discriminating between high and low performers; (iv) identifying items which are absolutely true or false may lead to assessment of trivial knowledge; (v) there are difficulties with constructing flawless items; (vi) they may not encourage learning around the items; and (vii) they may not assess what they purport to assess. Many assessment agencies abandoned the use of this format decades ago due to these shortcomings. The use of single best answer (SBA) and extended matching item (EMI) formats helps overcome or minimize the above weaknesses. Assessors who plan to change to SBA or EMI formats from true/false MCQs may, however, need to increase the number of questions to include a representative sample of the curriculum (lengthening the question paper). However, they may not need to increase the examination time, as in general students can answer more SBAs or EMIs than true/false MCQs per unit time. It is time that we reflect upon the disadvantages of true/false MCQs and review their place in our assessment toolkit, as their use in summative examinations may not be fair to students, especially ‘good’ students.

Strategies for sustaining curricular changes in medical schools: a proctological view.

Major changes were introduced to medical curricula globally over the last two decades. They were driven either by external pressure from governing bodies or self-reflective processes. Though much has been written about the planning, initiation and implementation of such changes, fewer experiences of the strategies to achieve sustainability have been shared in the medical literature despite their long and successful sustainability. The necessity was identified and motivation was generated for medical curricular reforms in Sri Lanka by pioneering group of academics who reflected upon the existing process. Major changes have been sustained for more than a decade successfully. The Faculty of Medicine University of Indonesia in its short history of curricular reforms, in accordance to the government’s proposals has adopted similar measures for their sustainability. Though we involved in neither the change nor the sustainability processes in those countries thoroughly, we had the opportunity for upward observation. We attempted to compare the successful measures of sustainability in the two countries and correlate our conclusions with the experiences and recommendations published by others. Leading the process cleverly, formulating a suitable management structure, decentralising the decision making power, managing resources effectively, collaborating with different parties in the institution, keeping balance between top-down and bottom-up approach, enhancing motivation of cohort, maintaining flexibility and adaptability throughout the process, establishing functioning system of on-going evaluation early, networking with external professional bodies, continuing training programme regularly and frequently, and sharing the ownership seem to be generically effective as strategies for sustainability of changes in medical curricula.