Comparing narrative and multiple-choice formats in online communication skill assessment.

Objectives: We compared multiple-choice and open-ended responses collected from a web-based tool designated 'Case for Change', which had been developed for assessing and teaching medical students in the skills involved in integrating sexual risk assessment and behaviour change discussions into patient-centred primary care visits.

Methods: A total of 111 Year 3 students completed the web-based tool. A series of videos from one patient encounter illustrated how a clinician uses patient-centred communication and health behaviour change skills while caring for a patient presenting with a urinary tract infection. Each video clip was followed by a request for students to respond in two ways to the question: 'What would you do next?' Firstly, students typed their statements of what they would say to the patient. Secondly, students selected from a multiple-choice list the statements that most closely resembled their free text entries. These two modes of students' answers were analysed and compared.

Results: When articulating what they would say to the patient in a narrative format, students frequently used doctor-centred approaches that focused on premature diagnostic questioning or neglected to elicit patient perspectives. Despite the instruction to select a matching statement from the multiple-choice list, students tended to choose the most exemplary patient-centred statement, which was contrary to the doctor-centred approaches reflected in their narrative responses.

Conclusions: Open-ended questions facilitate in-depth understanding of students' educational needs, although the scoring of narrative responses is time-consuming. Multiple-choice questions allow efficient scoring and individualised feedback associated with question items but do not fully elicit students' thought processes.