Formative Assessment of Diagnostic Testing in Family Medicine with Comprehensive MCQ Followed by Certainty-Based Mark

The choice of diagnostic tests in front of a given clinical case is a major part of medical reasoning. Failure to prescribe the right test can lead to serious diagnostic errors. Furthermore, unnecessary medical tests are a waste of money and could possibly generate injuries to patients, especially in family medicine.

In an effort to improve the training of our students to the choice of laboratory and imaging studies, we implemented a specific multiple-choice questions (MCQ), called comprehensive MCQ (cMCQ), with a fixed and high number of options matching various basic medical tests, followed by a certainty-based mark (CBM). This tool was used in the assessment of diagnostic test choice in various clinical cases of general practice in 456 sixth-year medical students.

The scores were significantly correlated with the traditional exams (standard MCQ), with matched themes. The proportion of "cMCQ/CBM score" variance explained by "standard MCQ score" was 21.3%. The cMCQ placed students in a situation closer to practice reality than standard MCQ. In addition to its usefulness as an assessment tool, those tests had a formative value and allowed students to work on their ability to measure their doubt/certainty in order to develop a reflexive approach, required for their future professional practice.

cMCQ followed by CBM is a feasible and reliable evaluation method for the assessment of diagnostic testing.