Evaluation of the effectiveness of progressive disclosure questions as an assessment tool for knowledge and skills in a problem based learning setting among third year medical students at The University of The West Indies, Trinidad and Tobago

BACKGROUND: At the University of the West Indies, Trinidad and Tobago, third year undergraduate teaching is a hybrid of problem-based learning (PBL) and didactic lectures. PBL discourages students from simply getting basic factual knowledge but encourages them to integrate these basic facts with clinical knowledge and skills. Recently progressive disclosure questions (PDQ) also known as modified essay questions (MEQs) were introduced as an assessment tool which is reported to be in keeping with the PBL philosophy. OBJECTIVE: To describe the effectiveness of the PDQ as an assessment tool in a course that integrates the sub-specialties of Anatomical Pathology, Chemical Pathology, Haematology, Immunology, Microbiology, Pharmacology and Public Health. METHODS: A descriptive analysis of examination questions in PDQs, and the students’ performance in these examinations was performed for the academic years 2011–2012, 2012–2013, and 2013–2014 in one-third year course that integrates Anatomical Pathology, Chemical Pathology, Haematology, Immunology, Microbiology, Pharmacology and Public Health. RESULTS: The PDQs reflected real life scenarios and were composed of questions of different levels of difficulty by Blooms’ Taxonomy, from basic recall through more difficult questions requiring analytical, interpretative and problem solving skills. The integrated PDQs in the years 2011–2012, 2012–2013, 2013–2014 respectively was 52.9, 52.5, 58 % simple recall of facts. By sub-specialty this ranged from 26.7 to 100 %, 18.8 to 70 %, and 23.1 to 100 % in the 3 years respectively. The rest required higher order cognitive skills. For some sub-specialties, students’ performance was better where the examination was mostly basic recall, and was poorer where there were more higher-order questions. The different sub-specialties had different percentages of contribution in the integrated examinations ranging from 4 % in Public health to 22.9 % in Anatomical Pathology. CONCLUSION: The PDQ asked students questions in an integrated fashion in keeping with the PBL process. More care should be taken to ensure appropriate questions are included in the examinations to assess higher order cognitive skills. However in an integrated course, some sub-specialties may not have content requiring higher cognitive level questions in certain clinical cases. More care should be taken in choosing clinical cases that integrate all the sub-specialties.