A Comparison of Students, Scores in Multiple- Choice and Essay Questions in Mother and Child Health Examination

INTRODUCTION

Assessment is one of the most important components of each educational program, and if accomplished well, can improve students’ motivation for learning and provide educators with useful feedback [1]. Learning assessment is often one of the most difficult and time-consuming aspects of education, greatly affecting students’ studying mode [2]. Conventionally, different types of questions such as essay, short answer, structural, and objective have been employed for assessment of students’ knowledge. Essay questions, despite their greater credibility compared to other types of questions, were applied less due to being time-consuming in terms of scoring. This question format allows students to be flexible while writing answers and individually reflecting on their skills [3 ] .  Essay questions also provide specific feedback to direct future learning [2].  A study reported that essay questions had higher sensitivity in comparison with objective questions in predicting the students’ performance [4]. The objective questions, making students find correct answers, require comparably shorter time to score, and are employed in assessment of medical students in different courses. These questions are capable of covering most of the content and are highly reliable. Multiple-choice, true-false, and matching types, are classified as objective questions (5,6). Designing multiple-choice questions (MCQs) to be used repeatedly in final examinations is difficult and time consuming, even for professional educators; besides, with elimination of negative scores, association of examination  score with learners’ knowledge seems poor [7]. In designing these questions, it should be noted that these questions must include the cognitive educational purposes, which are mentioned in the lesson plan [8,9]. MCQs have high reliability, but their validity, particularly at the level of knowledge and considering the construct design principles, have been noticeable issues in educational studies. Clearly, if an examination is not well-designed in terms of questions’ taxonomy choice and/or structural rules, it will not yield an acceptable level of content validity or construct. Therefore, not only the main role of examination as a complementary and vital component of educational cycle will be lost, but also it will negatively affects learners’ motivation and threatens the efforts of teachers and educational system [1]. In comparing essay with MCQs regarding their predictive capability, various studies have reported different findings.  According to one, MCQs have a lower sensitivity to predicting students’ performance than essays [10]. However, as reported by another study, essay questions have higher validity than the MCQs, but can’t measure the qualification aspects of students more profoundly in contrast to MCQs [2]. Importantly, students’ awareness of conventional structure of questions has replaced question-reading with thinking during the learning process ; and also the approach to question-reading has frantically reduced welcoming class sessions which is an environment for communicating thoughts, analyzing data, and even teaching research [11].  One study reported that an important section of one’s preparation for examination is indeed his or her assessment of its method [12]. In Mother and Child 

Health course in Shahrekord University of Medical Sciences, the assessment of students’ performance is made with multi-choice questions. It seems that graduated nursing students, working in hospitals and health centers, have little knowledge about the mother and child health subject. The objective of the present study was to compare the scores obtained by the nursing students while answering essay and multiple choice questions about mother and child health subject. 

METHODS

In Shahrekord University of Medical Sciences, thirty or thirty-one students in nursing course are accepted each year who study the Mother and Child Health subject in the 3^rd semester. To help generate the findings of this study, we studied the students of 4^th  semesters; i.e. 121 nursing students between 2010 and 2012 who had taken the Mother  and Child Health subject.  In this course, the final evaluation is conventionally carried out through MCQs. In the current study, we compared the essay with MCQs. Data collection was performed by Personal Information Form and the questions of Mother and Child Health examination.  For this study, to examine mother and child health, first, the essay, consisting 40 questions, was given to the students to answer during the 40-minute allotted time.  At the end of this section and after the students had delivered their essay papers, a multiple-choice questionnaire composed of 40 questions that covered a similar content, was given to students to answer within 40 minutes. In essay and multiple choice questionnaires, 50% of questions were designed in taxonomy I (recalling information and memorizations) and 50% in taxonomy II (interpreting information). None of the questions in either exam had a negative score; this issue was inscribed on their papers. The value of essay questions and MCQs were equivalent; besides, each semester the questions were replaced with those of similar content. After the examination, the papers were scored by the teachers and controlled by other two colleagues. In analyzing questions, difficulty index, discrimination index of questions was detected and compared between the two exams. To consider the research ethics, only the scores of MCQ examination was noted for final evaluation as the real score of student based on 20 and was delivered to Education Deputy of Faculty. Analysis of the data was performed by using paired t-test and Pearson correlation coefficient and P

RESULTS

The mean age of all participants was 21.31±1.4. Sixty-Eight percent of them were female and Thirty-Two percent were male. There was not a significant difference with regards to difficulty and discrimination indices between the two kinds of questions for all the four semesters of study.  The comparison of students’ mean scores in two types of evaluation is presented in table 1 that indicates higher scores of MCQs compared to essay questions in all four years in a significant manner (P<0.001). The minimum score obtained in essay questionnaire was 11.50 and the maximum  was 16.50.  In MCQs questions, these scores were 14.00 and 18.00. A positive correlation was observed between the scores in the two types of questions [n=121, r=0.93, p