Creating assessments as an active learning strategy: what are students' perceptions? A mixed methods study

Background: Teaching students how to create assessments, such as those involving multiple-choice questions (MCQs), has the potential to be a useful active learning strategy. In order to optimize students' learning, it is essential to understand how they engage with such activities. Objective: To explore medical students' perceptions of how completing rigorous MCQ training and subsequently writing MCQs affects their learning. Design: In this mixed methods exploratory qualitative study, eighteen second-year medical students, trained in MCQ-writing best practices, collaboratively generated a question bank. Subsequently, the authors conducted focus groups with eight students to probe impressions of the process and the effect on learning. Responses partially informed a survey consisting of open-ended and Likert rating scale questions that the remaining ten students completed. Focus group and survey data from the eighteen participants were iteratively coded and categorized into themes related to perceptions of training and of collaborative MCQ writing. Results: Medical students felt that training in MCQ construction affected their appreciation for MCQ examinations and their test-taking strategy. They perceived that writing MCQs required more problem-solving and content-integration compared to their preferred study strategies. Specifically, generating plausible distractors required the most critical reasoning to make subtle distinctions between diagnoses and treatments. Additionally, collaborating with other students was beneficial in providing exposure to different learning and question-writing approaches. Conclusions: Completing MCQ-writing training increases appreciation for MCQ assessments. Writing MCQs requires medical students to make conceptual connections, distinguish between diagnostic and therapeutic options, and learn from colleagues, but requires extensive time and knowledge base.