Purpose
Medical education relies heavily on multiple-choice questions (MCQs) that assess an interconnected understanding of basic and clinical sciences vital for clinical decision-making. Experts create MCQs based on their schemas, which serve to organize and retrieve information. These schemas help distinguish between diagnoses using clinically relevant features. However, medical students use qualitatively different knowledge than physicians while constructing a representation of a clinical case. The representation by novices and medical students contains detailed basic science knowledge acquired in medical school. As students become more expert, this detailed biomedical knowledge becomes gradually encapsulated. Thus, experts often struggle to translate their encapsulated knowledge into accessible formats for students. Experts and novices structure their knowledge differently. While experts utilize hierarchical illness scripts, novices often view concepts as isolated and equally important. Therefore, educators must deconstruct their knowledge to develop MCQs, guiding students through complex content.
Methods
Two tools, Integrated Illness Scripts (IIS) and SOLO taxonomy-based item writing templates, will be presented to assist faculty in deconstructing their knowledge. IIS enhances traditional illness scripts by incorporating basic science explanations for common clinical features. The SOLO taxonomy templates also help craft MCQs at varying cognitive levels: unistructural, multi-structural, relational, and extended abstract. The unistructural and multi-structural levels assess basic competencies, while the relational level focuses on how elements interact within broader systems. The extended abstract level emphasizes complex skills, such as analyzing variable relationships across multiple structures, diagnosing and treating, and applying knowledge to new contexts.
Results
IIS and SOLO Taxonomy templates enable faculty to confidently deconstruct their encapsulated knowledge and design structured MCQs that measure higher cognitive levels.
Conclusion
Intentionally deconstructing expert knowledge to formulate well-structured MCQs is essential for fostering cognitive integration of basic and clinical sciences in medical education.