Multiple choice questions. The debate goes on

The clinical comprehensive examination given to Pahlavi University medical students in their last year was designed to include three types of questions: multiple choice questions (MCQ's) testing factual recall, MCQ's measuring clinical problems solving ability, and simulated patient management problems (PMP's). The scores of the three types of questions were compared with the five-year cumulative class standing and with each other. It was found that the class standing was very highly correlated with MCQ's testing for recall of information. The relation progressively lessened with problem solving MCQ's and PMP's. In the extremes of class standing there was no significant correlation with problem solving MCQ's and a significant but negative correlation with PMP's. Similar results were obtained when recall type MCQ's were compared with problem solving MCQ's and PMP's. It is concluded that the various determinants of class standing (MCQ's, oral exams, 'performance' reports, etc) are probably based on ability for factual recall and that the usual variety of MCQ's are a poor discriminating index of medical competence. It is, however, possible to write MCQ's that are better able to measure the more significant objectives of medical education.