Using MCQ response certainty to determine how aspects of self-monitoring develop through a medical course

Area of Science:

• Medical education
• Healthcare professional development
• Clinical decision-making assessment

Background:

• Self-monitoring of clinical decision-making is crucial for healthcare professionals.
• Assessing medical students' self-monitoring abilities can be achieved through their response certainty in assessments.
• This study explores insightfulness, safety, and efficiency in medical students' self-monitoring.

Purpose of the Study:

• To introduce a method for tracking medical students' self-monitoring of clinical decision-making over time.
• To define and measure insightfulness, safety, and efficiency based on certainty and correctness of multiple-choice question (MCQ) responses.
• To analyze how these self-monitoring aspects evolve throughout a medical curriculum.

Main Methods:

• Medical students provided certainty of correctness for their answers on biannual MCQ progress tests.
• Insightfulness was defined as higher correctness with increasing certainty.
• Safety was defined as a high probability of correctness with high certainty, and efficiency as a low probability of correctness with low certainty.

Main Results:

• Patterns of self-monitoring aspects were consistent across two student cohorts.
• Nearly all students demonstrated insightfulness throughout the course.
• Safety outcomes were often undetermined, but absence of safety was more common mid-course, while presence increased later. Efficiency was prevalent mid-course but decreased later.

Conclusions:

• Medical students exhibit consistent insightfulness during their training.
• Students appear to balance safety and efficiency, potentially reflecting a learning progression from understanding positive to negative decision implications.
• The findings suggest a dynamic interplay between efficiency and safety in developing clinical judgment.