Evaluation of the cognitive level of essay questions of an undergraduate medical program in Sri Lanka, using bloom’s taxonomy

Background:  Medical curricula should encourage the development of advanced cognitive skills. Examination questions are an indicator of the cognitive level expected of students. However, it is believed that many factors, such as difficulty in maintaining objectivity in marking, large numbers of scripts and poor language ability of students lead to compiling of essay questions requiring lower cognitive levels.

 

Objectives: The objective of the study was to categorize essay questions of the undergraduate medical program of a Sri Lankan university according to the cognitive level tested.

 

Methods:  Essay questions were classified into cognitive levels based on Bloom’s taxonomy and subsequently categorized broadly as those requiring lower order thinking skills (LOTS), middle order thinking skills (MOTS) and higher order thinking skills (HOTS). Analysis was done based on discipline and components of study (pre-clinical, paraclinical and clinical).

 

Results and Discussion:  Most questions required LOTS. However, a majority of Physiology questions required HOTS while a majority of questions in the Communication Learning and Research module, Anesthesiology, Gynecology and Obstetrics and Paediatrics required MOTS. Evaluation of questions at pre-clinical, para-clinical and clinical components revealed a focus on questions requiring LOTS at all levels.  However, the proportion of questions requiring MOTS increased from pre-clinical to clinical part of the course while the proportion of questions requiring HOTS decreased from the pre-clinical to the clinical part of the course.  It is advisable that relevant academic departments reflect upon these findings in view of  improving the impact of their examinations on development of higher order cognitive skills among students.

 

Conclusions: Essay questions requiring LOTS predominate in most disciplines and at all levels of the course. An increase in the proportion of questions requiring MOTS and a decline in the proportion of questions requiring HOTS was observed from pre-clinical to the clinical part of the course. Systematic evaluations of examination questions to identify their cognitive levels would generate valid evidence to reflect upon institutional commitments to improve higher order cognitive skills among students.