Integrated MCQs–Part I: A Specialists’ Opinion

Thanks to the connectivity of the world wide web, I had a fleeting (via one of my mentors) conversation with one of the giants in medical education, whose work has always been a source of awe, inspiration and enjoyment for me. Thanks to an ongoing discussion on a Medical Education (India) email list, which was forwarded to me and a friend by our mentor, we came in touch with Dr. Vinay Kumar, of Kumar/Abbas/Fausto fame.

What? That ring no bells? What about this, then:


Aaah. Two of my most favorite medical reads of all times!


So here was the thing. The ongoing discussion was on how to frame MCQs that don’t just test the students’ ability to mug questions. Dr. Kumar sent along a very rough draft of three questions demonstrating that very concept. I brushed it up, inserted the images and decided to post them here on my blog as the first part in what I am expecting to be a trilogy of posts on MCQs.

Here are the three MCQs Dr. Kumar sent along with the rationale for their being asked:

[I have had problems with embedding Google Docs before and on top of that, I am writing this using Windows Live Writer, so I won’t know if it gets messed up in the blog (it shows up fine on the preview). I hope this sticks! Do let me know in the comments or via email if the thing is not showing up properly]

The basic premise of all these questions is that they are meant to be 2/3 step questions. None of them directly ask for an answer. The answers have to be worked out, and in some cases, the options have to be weeded out, in several steps. each of these steps forms an important part of the exercise in which different aspects of the students’ learning are tested.

In contrast, take a look at some of the questions that were asked (often time and again) in the Indian PG entrance examinations (all these questions were supposedly asked in AIPGMEE 2011 – as recalled by exam takers):


A purely information seeking question.


Negative questions: the bread and butter of AIPGMEE question setters. In my opinion they are good for nothing but testing proficiency in understanding convoluted syntax.


Questions about zebras, very popular too!


The rare multi step question (which is, incidentally, once again, in relation to a zebra!)

I know the image quality is awful, but these pics were taken off a book of recalled questions with my low power mobile camera. I hope they are legible enough to drive home the point I am trying to make here.

So, in conclusion, I would just like to say that depending on how the MCQs are framed, these questions may either be a great tool to test the competence of the examinees from a number of viewpoints, but if not, then they just end up being a mugging contest where rote based medicine rules the roost. Please do keep in mind the fact that I am not against rote based learning, heck we have to learn some stuff by heart so that we can apply them in other fields. My opposition is to make the rote based thing the primary criteria. Unfortunately, this is probably the only way out since unlike the USMLE, AIPGMEE is more of an elimination examination and in such a scenario, what one does not know becomes as much an important decider in the final outcome as what one does know.


6 thoughts on “Integrated MCQs–Part I: A Specialists’ Opinion

  1. yeah completely agree wid u man..dis is d cause y our noble profession is earning bad names at many junctures..dis is d reason many people dont get intersted in dis field..mugging is necessary at some steps but being d sole criteria of selecting competent candidates…dats 2 much..hope our voices dont fall on deaf ears n d selection commitee goes a few steps ahead 2 make it a real exam..

    • Thanks for caring to read and leave a comment! With a lot of changes expected in the medical education scenario, I believe these changes are going to come in. Slowly but surely… that’s all we can hope, eh?

  2. but it is depressing that we have to make it this way only for now…In India by the time that change comes I will be 50..Its not that I dont love my country but we are just that slow

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