Recall Type vs Problem-based Tests for Formative Assessment in
Undergraduate Medical Students

However, the reliability and standardization of FAs is still uncertain [4]. So far, no studies have been undertaken on the impact of FA or type of questions used during FA [5]. Usually one type of MCQs is of recall-type questions, which are short questions about theory. The second type involves problem-based questions, which require critical thinking. Although, feedback on the performance is more important in formative assessment, rather than type of questions. The purpose of the present study was to compare the two types of FA with the final examination results and previous grade.

We studied fourth-year medical students who enrolled in the Department of Medicine at our university from April 2015 to March 2016. There were four groups, each with 19 or 20 students. The students took a formative examination, which consisted of 50 recall-type and 50 problem-based MCQs. At the end of the course, all the students underwent an SA with 50 recall-type and 50 problem-based MCQs. For the MCQs, we had two sets of questions (i.e., two sets of recall-type and two sets of problem-based questions) and alternated the questions that appeared between the groups. We did not return the examination papers to the students, thereby eliminating the risk of the content being circulated among students who had yet to take an examination.

We observed that the FA scores (either recall or problem-based) significantly correlated with Grade Point Average (GPA) for years 1–3 (r=0.33, P=0.003). The final examination scores (SA) also correlated significantly with GPA (r=0.42, P<0.001); the recall type of FA showed significant correlations with the summative score (r=0.24, P=0.036); though, the degree of correlation was not high. The problem-based type of examination displayed no significant correlation with the final examination scores (r=0.15, P=0.18). The total FA score evidenced a low correlation (r=0.24) with SA. The students obtained better scores at the end of the course. The mean formative and summative scores are represented in Table I.

TABLE I	Formative Assessment and Summative Assessment Scores in Fourth-year Medical Students (N= 77)

We found that the GPA during the first three years of study also correlated with the FA and SA scores. This result indicates that most students who achieved good academic marks during their preclinical studies also obtained favorable results in their clinical years.

We conclude that FA using recall-type questions is associated with summative achievement. The formative and summative scores also correlate with GPA in the preclinical period.

Acknowledgement: Mr Jason Cullen for editing the manuscript, Ms. Worachanee Imjaijit for statistical analysis, Ms Ratchadaporn Inunchote for typing the manuscript.

Contributors: TT: designed the study and was involved with data acquisition, analysis and interpretation as well as manuscript preparation; SS: edited the manuscript and made revisions for critically important content; CT and MB: prepared the questions for the formative and summative examinations and edited the manuscript.

Funding: The research fund from Navamindradhiraj University, Bangkok,Thailand. Competing interest : None stated.

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