Too Many Choices

One night I was playing a REALLY cool “game” (if you can even call it that) with my boyfriend and brother: we were trying to list all 50 states from memory, as originally seen on an episode of Friends. (It’s really hard—try it.)

Anyway, when we finally finished, we were trying to remember state capitols (I told you we’re cool), and here’s what happened: my brother would suggest an incorrect state capitol, and then my boyfriend would suggest an alternative incorrect one. I’d be thinking, Oh, I always thought it was Whatsitsfaceville, but I guess that’s not it. Then we’d look up the answer and what I was thinking turned out to be right. This happened for about 3 different capitols.

Since I am so cool, this of course got me thinking about multiple-choice tests. Do they really test knowledge or do they just mislead you by the power of suggestion?

The truth is that if someone had asked me the capital of Missouri, I would have said Jefferson City. But because 2 different people suggested incorrect answers first, I doubted my memory and didn’t speak up. (This seems to happen a lot. I definitely have a problem with academic self-esteem.)

Some types of questions are really good at testing what I know and have helped me learn a lot. For example, a question will be about a patient with the cardinal symptom of one disease but will include key details that should lead you to a different diagnosis. Those questions are great, in my opinion, because you have to overcome your bias towards the chief complaint and most obvious choice to select the right answer.

So the conclusion I’ve drawn is that multiple-choice tests are a good measure of: 1) knowledge that will often be contradicted, and 2) one’s ability to spot aberrant information or conclusions.

But there are some specialties/situations/subjects in which a doctor is not often exposed to others’ conclusions. For example, a radiologist usually looks at each image independently, without another doctor suggesting diagnoses over their shoulder. (At least, that is my current impression. I might be misled.) A pathologist looks at slides alone. (Of course there is very often the question of cancer, but the pathologist is aware of that bias.)

If that’s true and I’m not misled, why are our Histology and Neuroscience practical exams multiple-choice? (Our Gross Anatomy practicals aren’t.) …The answer is probably that it is too hard to grade 240 exams with 50 poorly-spelled and crudely written answers on them. Sad but probably true.