Recommendation 4. Establish curriculum development demonstration project awards. The National Institutes of Health or private foundations, or both, should establish a program that funds demonstration projects in behavioral and social science curriculum development at U.S. medical schools.
Assessment of individual students is an essential element of the instructional process, making it possible to determine the extent to which learning objectives have been met through a particular curriculum or instructional methodology (Blue et al., 2000). Assessment also focuses learners and program participants on the most important aspects of a program and often drives learning. Thus, it is important to consider all aspects of student assessment, from internal examinations within courses to external licensing examinations, to fully assess both students and the adequacy of the curriculum.
Most medical schools test their students throughout the curriculum using multiple-choice examinations with questions written by faculty members (Downing, 2002a; Jozefowicz et al., 2002). Although few studies evaluate the quality of these in-house examinations, a recent study from the NBME revealed that violations of the most basic item-writing principles are common in the achievement tests used in medical schools (Downing, 2002a; Jozefowicz et al., 2002). Poorly crafted test questions add an artificial layer of difficulty to examinations that can result in inflation or deflation of test scores (Downing, 2002a,b). Many faculty members simply do not have the psychometric expertise to write high-quality tests, a point that applies especially to faculty in the behavioral and social sciences, in which the content is often heavily contextual.
Multiple-choice questions are the most widely used format for knowledge assessment because, unlike open-ended questions, they allow for consistency in grading, a sampling of student knowledge in an area with vast amounts of information, and a cost-effective means of assessment. In addition, large numbers of examinations can be scored more easily, and the test is less time-consuming to administer (Anbar, 1991; Edelstein et al., 2000; Veloski et al., 1999). Nontraditional testing methods, however, such as short essay questions, structured oral examinations, and objective structured clinical examinations, may be better suited for use in the behavioral and social sciences because they reveal, more so than other modes of testing, how the student frames problems, appraises and replies to alternative views, evaluates evidence, and defends conclusions. As discussed above, regardless of the testing method used, it is critical that faculty development and assistance resources be provided to ensure that faculty produce high-quality evaluations of behavioral and social science content.
The material covered on the U.S. Medical Licensing Examination (USMLE)