title: The impact of two multiple-choice question formats on the problem-solving strategies used by novices and experts.
abstract: BACKGROUND
  Pencil-and-paper examination formats, and specifically the standard, five-option multiple-choice question, have often been questioned as a means for assessing higher-order clinical reasoning or problem solving. This study firstly investigated whether two paper formats with differing number of alternatives (standard five-option and extended-matching questions) can test problem-solving abilities. Secondly, the impact of the alternatives number on psychometrics and problem-solving strategies was examined.
  
  
  METHODS
  Think-aloud protocols were collected to determine the problem-solving strategy used by experts and non-experts in answering Gastroenterology questions, across the two pencil-and-paper formats.
  
  
  RESULTS
  The two formats demonstrated equal ability in testing problem-solving abilities, while the number of alternatives did not significantly impact psychometrics or problem-solving strategies utilized.
  
  
  CONCLUSIONS
  These results support the notion that well-constructed multiple-choice questions can in fact test higher order clinical reasoning. Furthermore, it can be concluded that in testing clinical reasoning, the question stem, or content, remains more important than the number of alternatives.
authors.affiliation: Department of Medicine, University of Calgary, Health Sciences Centre, 3330 Hospital Drive NW, T2N 4N1, Calgary, Alberta, Canada. coderre@ucalgary.ca
authors.forename: Sylvain P
authors.initials: SP
authors.lastname: Coderre
authors.forename: Peter
authors.initials: P
authors.lastname: Harasym
authors.forename: Henry
authors.initials: H
authors.lastname: Mandin
authors.forename: Gordon
authors.initials: G
authors.lastname: Fick
mesh_terms: D000328:Adult; D002170:Canada; D002983:Clinical Competence; D003657:Decision Making; D003680:Deglutition Disorders / Q000175:diagnosis; D003967:Diarrhea / Q000175:diagnosis; D004521:Educational Measurement / Q000379:methods*; D005762:Gastroenterology / Q000193:education*; D005767:Gastrointestinal Diseases / Q000175:diagnosis*; D006801:Humans; D008099:Liver / Q000201:enzymology; D008111:Liver Function Tests; D008128:Logic; D008875:Middle Aged; D009325:Nausea / Q000175:diagnosis; D010364:Pattern Recognition, Visual; D011340:Problem Solving; D011594:Psychometrics / Q000379:methods*; D013337:Students, Medical / Q000523:psychology; D011795:Surveys and Questionnaires