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Cited by 46Innovations in Medical EducationInnovative Teaching MethodsProblem and Project Based Learning

Does developing multiple-choice Questions Improve Medical Students’ Learning? A Systematic Review

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Touissi, Youness, Hjiej, Ghita, Hajjioui, Abderrazak, Ibrahimi, Azeddine, Fourtassi, Maryam·2022·Medical Education Online
DOI 10.1080/10872981.2021.2005505PMC PMC8725700
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Abstract

Practicing Multiple-choice questions is a popular learning method among medical students. While MCQs are commonly used in exams, creating them might provide another opportunity for students to boost their learning. Yet, the effectiveness of student-generated multiple-choice questions in medical education has been questioned. This study aims to verify the effects of student-generated MCQs on medical learning either in terms of students' perceptions or their performance and behavior, as well as define the circumstances that would make this activity more useful to the students. Articles were identified by searching four databases MEDLINE, SCOPUS, Web of Science, and ERIC, as well as scanning references. The titles and abstracts were selected based on a pre-established eligibility criterion, and the methodological quality of articles included was assessed using the MERSQI scoring system. Eight hundred and eighty-four papers were identified. Eleven papers were retained after abstract and title screening, and 6 articles were recovered from cross-referencing, making it 17 articles in the end. The mean MERSQI score was 10.42. Most studies showed a positive impact of developing MCQs on medical students' learning in terms of both perception and performance. Few articles in the literature examined the influence of student-generated MCQs on medical students learning. Amid some concerns about time and needed effort, writing multiple-choice questions as a learning method appears to be a useful process for improving medical students' learning.

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  • Students can benefit from AQG in self-directed learning, reinforcing their understanding of concepts and fostering critical thinking skills.

    “Students can also benefit from AQG in self-directed learning, reinforcing their understanding of concepts and fostering critical thinking skills [27].”

    From Docimological Quality Analysis of LLM-Generated Multiple Choice Questions in Computer Science and Medicine (2024) · cites this paper as [27]

    The Introduction describes student-created MCQs as an active-learning strategy that requires deep understanding and might develop problem-solving skills. The Discussion reports broadly improved grades from students writing MCQs. The paper does not establish these benefits for AQG, if that means automated question generation, or specifically demonstrate gains in self-directed learning or critical thinking. (LLM, conf=0.85)

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  1. [1]Lim J, Ko H, Yang JW, et al. Active learning through discussion: ICAP framework for education in health professions. BMC Med Educ. 2019 Dec; 19(1): 477. 31888595 PMC6937678
  2. [2]Hilliard RI. How do medical students learn: medical student learning styles and factors that affect these learning styles. Teach Learn Med. 1995 Jan; 7(4): 201– 13.
  3. [3]Al-Wardy NM. Assessment methods in undergraduate medical education. Sultan Qaboos Univ Med J. 2010 Aug; 10(2): 203– 209. 21509230 PMC3074721
  4. [4]Wynter L, Burgess A, Kalman E, et al. Medical students: what educational resources are they using? BMC Med Educ. 2019 Jan; 19(1): 36. 30683084 PMC6347772
  5. [5]Veloski JJ, Rabinowitz HK, Robeson MR, et al. Patients don’t present with five choices: an alternative to multiple-choice tests in assessing physicians’ competence. Acad Med. 1999 May; 74(5): 539– 546. 10353288
  6. [6]Galloway KW, Burns S. Doing it for themselves: students creating a high quality peer-learning environment. Chem Educ Res Pract. Jan 2015; 16(1): 82– 92.
  7. [7]Collins J. Writing multiple-choice questions for continuing medical education activities and self-assessment modules. RadioGraphics. 2006 Mar; 26(2): 543– 551. 16549616
  8. [8]Coughlin PA, Featherstone CR. How to write a high quality multiple choice question (MCQ): a guide for clinicians. Eur J Vasc Endovasc Surg. 2017 Nov; 54(5): 654– 658. 28870436
  9. [9]Olde Bekkink M, Donders ARTR, Kooloos JG, et al. Uncovering students’ misconceptions by assessment of their written questions. BMC Med Educ. 2016 Aug; 16(1): 221. 27558400 PMC4997739
  10. [11]Shakurnia A, Aslami M, Bijanzadeh M. The effect of question generation activity on students’ learning and perception. J Adv Med Educ Prof. 2018 Apr; 6(2): 70– 77. 29607334 PMC5856907
  11. [12]Rhind SM, Pettigrew GW. Peer generation of multiple-choice questions: student engagement and experiences. J Vet Med Educ. 2012; 39(4): 375– 379. 23187030
  12. [13]Foos PW, Mora JJ, Tkacz S. Student study techniques and the generation effect. J Educ Psychol. 1994; 86(4): 567– 576.
  13. [14]Denny P, Hamer J, Luxton-Reilly A, et al., “ PeerWise: students sharing their multiple choice questions,” in Proceedings of the Fourth international Workshop on Computing Education Research, New York, NY, USA, Sep. 2008, pp. 51– 58. doi: 10.1145/1404520.1404526. · DOI · Paper page
  14. [15]Bottomley S, Denny P. A participatory learning approach to biochemistry using student authored and evaluated multiple-choice questions. Biochem Mol Biol Educ. 2011 Oct; 39(5): 352– 361. 21948507
  15. [16]Olde Bekkink M, Donders ARTR, Kooloos JG, et al. Challenging students to formulate written questions: a randomized controlled trial to assess learning effects. BMC Med Educ. 2015 Mar; 15(1): 56. 25888863 PMC4404132
  16. [17]Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009 Jul; 6(7): e1000097. 19621072 PMC2707599
  17. [18]Ahmed KKM, Al Dhubaib BE. Zotero: a bibliographic assistant to researcher. J Pharmacol Pharmacother. 2011; 2(4): 303– 305. 22025866 PMC3198533
  18. [21]Reed DA, Beckman TJ, Wright SM, et al. Predictive validity evidence for medical education research study quality instrument scores: quality of submissions to JGIM’s medical education special issue. J Gen Intern Med. 2008 Jul; 23(7): 903– 907. 18612715 PMC2517948
  19. [22]Cook DA, Reed DA. Appraising the quality of medical education research methods: the medical education research study quality instrument and the Newcastle-Ottawa scale-education. Acad Med. 2015 Aug; 90(8): 1067– 1076. 26107881
  20. [23]Reed DA, Cook DA, Beckman TJ, et al. Association between funding and quality of published medical education research. JAMA. 2007 Sep; 298(9): 1002– 1009. 17785645
  21. [25]Shah MP, Lin BR, Lee M, et al. Student-written multiple-choice questions—a practical and educational approach. Med.Sci.Educ 2019 Mar; 29(1): 41– 43. 34457447 PMC8368101
  22. [26]Herrero JI, Lucena F, Quiroga J. Randomized study showing the benefit of medical study writing multiple choice questions on their learning. BMC Med Educ. 2019 Jan; 19(1): 42. 30704452 PMC6357371
  23. [27]Rajendiren S, Dhiman P, Rajendiren S, et al. Making concepts of medical biochemistry by formulating distractors of multiple choice questions: growing mighty oaks from small acorns. J Contem Med Edu. 2014 Jun; 2(2): 123– 127.
  24. [28]McLeod PJ, Snell L. Student-generated MCQs. Med Teach. 1996 Jan; 18(1): 23– 25.
  25. [29]Walsh JL, Harris BHL, Denny P, et al. Formative student-authored question bank: perceptions, question quality and association with summative performance. Postgrad Med J. 2018 Feb; 94(1108): 97– 103. 28866607 PMC5800328
  26. [30]Grainger R, Dai W, Osborne E, et al. Medical students create multiple-choice questions for learning in pathology education: a pilot study. BMC Med Educ. 2018 Aug; 18(1): 201. 30134898 PMC6103861
  27. [31]Rick Stone M, Kinney M, Chatterton C, et al. A crowdsourced system for creating practice questions in a clinical presentation medical curriculum. Med.Sci.Educ 2017 Dec; 27(4): 685– 692.
  28. [32]Fu-Yun Y, Chun-Ping W. Student question-generation: the learning processes involved and their relationships with students’ perceived value. Jiaoyu Kexue Yanjiu Qikan. 2012 Dec; 57: 135– 162.
  29. [33]Teplitski M, Irani T, Krediet CJ, et al. Student-generated pre-exam questions is an effective tool for participatory learning: a case study from ecology of waterborne pathogens course. J Food Sci Educ. 2018; 17(3): 76– 84.
  30. [35]Song D. Student-generated questioning and quality questions: a literature review. Res J Educ Stud Rev. 2016; 2: 58– 70.
  31. [36]Buja LM. Medical education today: all that glitters is not gold. BMC Med Educ. 2019 Apr; 19(1): 110. 30991988 PMC6469033
  32. [37]Twenge JM. Generational changes and their impact in the classroom: teaching generation me. Med Educ. 2009 May; 43(5): 398– 405. 19422486
  33. [38]Kurtz JB, Lourie MA, Holman EE, et al. Creating assessments as an active learning strategy: what are students’ perceptions? A mixed methods study. Med Educ Online. 2019 Dec; 24(1): 1630239. 31248355 PMC6610530
  34. [39]Baerheim A, Meland E. Medical students proposing questions for their own written final examination: evaluation of an educational project. Med Educ. 2003 Aug; 37(8): 734– 738. 12895254
  35. [40]Hassumani D, Cancellieri S, Boudakov I, et al. Quiz discuss compare: using audience response devices to actively engage students. Med Sci Educator. 2015; 3(25): 299– 302.
  36. [41]Koles P, Nelson S, Stolfi A, et al. Active learning in a Year 2 pathology curriculum. Med Educ. 2005 Oct; 39(10): 1045– 1055. 16178832
  37. [42]Rosenshine B, Meister C, Chapman S. Teaching students to generate questions: a review of the intervention studies. Rev Educ Res. 1996 Jun; 66(2): 181– 221.
  38. [43]Chamberlain S, Freeman A, Oldham J, et al. Innovative learning: employing medical students to write formative assessments. Med Teach. 2006 Nov; 28(7): 656– 659. 17594561
  39. [44]Walsh J, Harris B, Tayyaba S, et al. Student-written single-best answer questions predict performance in finals. Clin Teach. 2016 Oct; 13(5): 352– 356. 26450346
  40. [45]Jobs A, Twesten C, Göbel A, et al. Question-writing as a learning tool for students – outcomes from curricular exams. BMC Med Educ. 2013 Jun; 13(1): 89. 23787038 PMC3698068
  41. [46]Gooi ACC, Sommerfeld CS. Medical school 2.0: how we developed a student-generated question bank using small group learning. Med Teach. 2015; 37(10): 892– 896. 25310243
  42. [47]Harris BHL, Walsh JL, Tayyaba S, et al. A novel student-led approach to multiple-choice question generation and online database creation, with targeted clinician input. Teach Learn Med. 2015; 27(2): 182– 188. 25893940
  43. [48]Bobby Z, Radhika MR, Nandeesha H, et al. Formulation of multiple choice questions as a revision exercise at the end of a teaching module in biochemistry. Biochem Mol Biol Educ. 2012 May; 40(3): 169– 173. 22615224
  44. [49]Papinczak T, Peterson R, Babri AS, et al. Using student-generated questions for student-centred assessment. Assess Eval Higher Educ. 2012 Jun; 37(4): 439– 452.
  45. [50]Dehghani MR, Amini M, Kojuri J, et al. Evaluation of the efficacy of peer-learning method in nutrition students of Shiraz University of medical sciences. J Adv Med Educ Prof. 2014 Apr; 2(2): 71– 76. 25512923 PMC4235552
  46. [51]Goldsmith M, Stewart L, Ferguson L. Peer learning partnership: an innovative strategy to enhance skill acquisition in nursing students. Nurse Educ Today. 2006 Feb; 26(2): 123– 130. 16202483
  47. [52]Sircar SS, Tandon OP. Involving students in question writing: a unique feedback with fringe benefits. Am J Physiol. 1999 Dec; 277(6 Pt 2): S84– 91. 10644264

Cited by

Sorted by citations

Authors
Touissi, Y., Hjiej, G., Hajjioui, A., Ibrahimi, A., & Fourtassi, M.
Affiliations
  • Mohammed V University (MA)
  • Mohamed I University (MA)
  • Laboratory of Neurosciences, Faculty of Medicine and Pharmacy of Fes, Sidi Mohammed Ben Abdallah University, Fez, Morocco
  • Faculty of Medicine of Tangier, Abdelmalek Essaadi University, Tetouan, Morocco
ORCID
Venue
Medical Education Online
Publisher
Informa UK Limited
Published
2021-12-31
Volume
27
Issue
1
Pages
2005505-2005505
ISSN
1087-2981 (ISSN-L)
DOI
10.1080/10872981.2021.2005505
PMC
PMC8725700
OpenAlex
W4206789305
Cited by
46
References
2
Citations by year
2026: 9 · 2025: 10 · 2024: 13 · 2023: 11 · 2022: 3
FWCI
1.23
Type
journal article
Language
en
Open access
Licence
Locations
  • Medical Education Online (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Toubkal
Funders
no funding
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
  • Social Sciences › Education › Innovative Teaching Methods
  • Social Sciences › Education › Problem and Project Based Learning
Keywords
medical students, medical education, student perceptions, academic performance, active learning, question writing
MeSH terms
Education, Medical, Education, Medical, Undergraduate, Educational Measurement, Humans, Learning, Students, Medical

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