Evaluation of a 3D-MC examination format in anatomy

The quality of education in medical anatomy is a fundamental pillar of good clinical practice. Current reforms of the medical curriculum have resulted in major methodological changes in the teaching and testing of anatomy. A number of recent studies have however described a decrease in positive metrics of anatomical knowledge among students so taught. It has been suggested that the reduced anatomical knowledge measured in these studies may endanger patient safety. As proxy measures of exam quality, evaluation of the levels of students 'achievement in the examinations, assessment of the subjectively perceived level of question difficulty and analysis of exam satisfaction are each suitable parameters of investigation of medical education.

To address these issues with regard to medical education at the Charité-Universitätsmedizin Berlin, we have analyzed students' levels of achievement in the anatomical Three Dimensional Multiple Choice (hereafter, 3D-MC)-examination of 2,015 students matriculated in medical studies from Summer Semester of 2014 through Summer Semester of 2017. We either compared students' achievement levels of identical 3D-MC questions using models or prepared anatomical specimen. Furthermore, we have analyzed the type and frequency of cognitive levels used in the anatomical questions in relation to the students' level of achievement. Finally, we conducted an anonymous survey to measure students' (n = 207) and instructors' (n = 16) satisfaction with the 3D-MC-examination in comparison to other employed anatomical testing strategies.

Students' achievement is significantly enhanced with anatomical questions using models relative to those utilizing anatomical specimen. Over 80% of the anatomical questions in the 3D-MC-examinations assessed the lowest cognitive levels and higher cognitive question levels were accompanied by a significant decrease of the levels of students' performance. Our survey further revealed that both, students and instructors preferred the practical examinations in anatomy and that the difficulty levels of the 3D-MC-examination was perceived as being the lowest in comparison to the other anatomical testing strategies.

Testing levels of anatomical understanding using anatomical models is not comparable to human specimen, and thus using specimen before models should be preferred to learn and test close to an authentic medical situation. The application of anatomical models and low cognitive question levels in the examination reduces the subjectively perceived level of difficulty, encourages superficial learning, and therefore decreases the retention of anatomical knowledge.

Although students and instructors prefer practical examinations in anatomy, the current development does not reflect these results. Therefore, it would be recommendable to rethink the development of anatomical testing strategies based on the existing evidence.