To address the students’ reluctance to attempt and their apparent discomfort with clinical vignette based MCQs, we suggest inclusion of MCQ writing exercises in small groups. We will exhibit several ways of conducting these exercises and the attendees will then create different (NBME style) MCQs based on the same patient scenario. Students struggle with clinical vignette based MCQs because they mostly utilize identification of “buzz” words and rote memorization, without attempting to identify the clinical approach to a patient. The session should help the educators identify effective methods to address these issues with students involving them in both instruction and assessment.

1. Due to the increased cognitive load on medical students today, combined with the stress of clinical vignette based MCQ examinations, students attempt to “surface” learn instead of conceptually identifying the right approach to a clinical vignette. When they create a whole patient scenario with MCQs from scratch, it improves meta-cognitive development and encourages higher order thinking.
2. Students think of a case in a linear manner based on the module/ course they are taught a particular topic in. By encouraging the students to work on forming appropriate distractors, this exercise gives them an opportunity to revise what they have learned before and address any gaps in their knowledge.
3. Revision of the learning material is time consuming. By applying what they have learned in creating a clinical vignette and the subsequent MCQs, they will summarize the key revision points of the topic in addition to the differential diagnosis, thus helping to evolve the right approach to cases.
4. Traditional didactic methods of instruction are unidirectional and promote passive learning which can be less engaging and effective for both the instructor and the learner. By actively involving students in creation of a case and MCQs with well formed distractors, the small group session can be an excellent team building exercise relying on principles of both self-directed and peer-learning.

Agenda & Methods

• 20 minutes: Formal presentation including
  1. Introduction of the presenters
  2. Present the rationale behind the session
  3. Enlist the learning outcomes for the attendees
  4. Demonstration of ways to create a case and MCQs based on the case scenario
  5. Describe the team exercise for the day
• 10 minutes: Group formation to
  1. Assign team leader
  2. Finalize topic for case and MCQ creation
• 30 minutes: Group discussion and exercise to
  1. Decide at least one method of creating a clinical vignette
  2. Assign parts of vignette among the members of the teams
  3. Identify at least 3 higher order lead-in questions for the vignette
  4. Develop reasonable and justifiable homogenous distractors for each lead-in question
  5. Collaborate to write a clinical vignette for each distractor (optional)
• 20 minutes: Team leader presents the clinical vignette and questions
• 10 minutes: Open discussion to
  1. Usefulness of the session
  2. Possibilities for incorporation into the curriculum