A Qualitative Exploration of Student Cognition When Answering Text-Only or Image-Based Histology Multiple-Choice...

Area of Science:

• Medical Education
• Cognitive Science

Background:

• Assessing medical students' image interpretation skills is crucial but lacks robust evidence.
• Medical education increasingly relies on visual-spatial reasoning.

Purpose of the Study:

• To investigate how medical students approach image interpretation in histology multiple-choice questions (MCQs).
• To analyze the impact of image relevance on student performance and verbalizations.

Main Methods:

• Thirty medical students participated in a randomized controlled trial, completing histology MCQs.
• Think-aloud protocols were used to capture students' cognitive processes during question-answering.
• Verbalizations were coded using a realist, inductive approach to identify themes.

Main Results:

• High-performing students were more likely to generate answers independently, while lower performers focused on option elimination.
• Image relevance significantly influenced student verbalizations; images essential for answering elicited more specific comments.
• Student self-identified learning styles and image presence had no consistent impact on question statistics.

Conclusions:

• Histology MCQs should include only relevant images to accurately assess interpretation skills and avoid extraneous cognitive load.
• Assessment design must align with the skills being tested for authenticity and constructive alignment.