Intended for healthcare professionals

Clinical Review ABC of learning and teaching in medicine

Written assessment

BMJ 2003; 326 doi: (Published 22 March 2003) Cite this as: BMJ 2003;326:643
  1. Lambert W T Schuwirth,
  2. Cees P M van der Vleuten

    Some misconceptions about written assessment may still exist, despite being disproved repeatedly by many scientific studies. Probably the most important misconception is the belief that the format of the question determines what the question actually tests. Multiple choice questions, for example, are often believed to be unsuitable for testing the ability to solve medical problems. The reasoning behind this assumption is that all a student has to do in a multiple choice question is recognise the correct answer, whereas in an open ended question he or she has to generate the answer spontaneously. Research has repeatedly shown, however, that the question's format is of limited importance and that it is the content of the question that determines almost totally what the question tests.

    Choosing the most appropriate type of written examination for a certain purpose is often difficult. This article discusses some general issues of written assessment then gives an overview of the most commonly used types, together with their major advantages and disadvantages


    • A score that a student obtains on a test should indicate the score that this student would obtain in any other given (equally difficult) test in the same field (“parallel test”)

    • A test represents at best a sample—selected from a range of possible questions. So if a student passes a particular test one has to be sure that he or she would not have failed a parallel test, and vice versa

    • Two factors influence reliability negatively:

      Sample error—The number of items may be too small to provide a reproducible result

      Sample too narrow—If the questions focus only on a certain element, the scores cannot generalise to the whole discipline

    This does not imply that question formats are always interchangeable—some knowledge cannot be tested with multiple choice questions, and some knowledge is best not tested …

    View Full Text

    Log in

    Log in through your institution


    * For online subscription