Background: Educators need approaches to assess medical students' abilities to apply and integrate concepts essential to medical practice.
Description: We used a multimethod approach to examine the quality of essay questions intended to elicit medical students' ability to apply and integrate their understanding of medical concepts.
Evaluation: Three educators assigned essay questions (n = 120) to one of four levels of cognition. Kappa was computed before and after discussion. Faculty (n = 46) critiqued essay quality using a checklist (97% response), and students completed a questionnaire about the learning environment (91% response).
Conclusions: We identified effective approaches to evaluate the quality of essay questions and to train faculty to write essay questions of sufficient complexity. This systematic review of essay questions also encouraged review of the curriculum to determine if core concepts were being taught. It is feasible to have faculty write and critique essay questions targeted at higher levels of cognition.
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