Assessment as Learning: A Mixed-Methods Study on Pre-Clinical Medical Student-Led Generation of Scenario-Based Multiple Choice Questions.

Purpose: Learning basic sciences divorced from clinical practices is suboptimal. Several student-centered learning strategies were introduced to enhance self-regulated learning while adopting learning techniques centered on assessment receives much less attention. This study aimed to explore the perception and efficacy of engaging early-phase preclinical medical students in generating scenario-based Multiple-choice questions (MCQs) targeting high cognitive levels.

Methods: This study is a quasi-experimental mixed-method study conducted among preclinical second-year medical students. An intervention group involved students who participated in item creation, and a control group included those who did not. The two groups were exposed to mock exams and were asked to complete a self-administered questionnaire and participate in focused group discussions on their perceptions.

Results: Out of 135 students, 48.9% created from 1 to 10 items. Item creators had significantly higher formative scores (34.3 ±10.5) than non-creators (29.6 ±10.6) (p = 0.010), and their GPA was also significantly better (B+ grade: 42.4% vs 21.7%; p = 0.015). Despite these academic variations, above 75% of the two groups were satisfied or very satisfied with non-significant variations. Formative assessment positively correlated with GPAs (rs = 0.74) and the number of developed items (rs = 0.39). The adopted strategy imposed a positive effect on the learning process and fostered procedural soft skills and student values. It allowed students to experience positive emotions and feelings of entertainment during learning and changed their perception of scenario-based MCQs. Students prefer generating such items in other subjects.

Conclusion: The student-led approach to generating clinical scenario-based MCQs demonstrates significant promise as an innovative pedagogical approach in medical education. Involving preclinical students in developing high cognitive levels of MCQs is not merely a tool for evaluation but a versatile pedagogical strategy that can be adapted to various disciplines to enhance learning and engagement and help students transition to the clinical years.