Problem-solving strategies used in anatomical multiple-choice questions.

Background And Aims: Multiple-choice questions (MCQ) in the anatomical sciences are often perceived to be targeting recall of facts and regurgitation of trivial details. Moving away from this assumption requires the design of purposeful multiple-choice questions that focus on higher-order cognitive functions as opposed to rote memorization. In order to develop such questions, it was important to first understand the strategies that students use in solving multiple-choice questions. Using the think-aloud protocol, this study seeks to understand strategies students use in solving multiple-choice questions. Specifically, it seeks to uncover patterns in the reasoning process and tactics used when solving higher and lower order MCQ in anatomy. The research also provides insights onto how these strategies influence the student's probability of answering questions correctly.

Methods: Multiple-choice questions were created at three levels of cognitive functioning based on the ideas, connections, extensions (ICE) learning framework. The think-aloud protocol was used to unravel problem-solving strategies used by 92 undergraduate anatomy students as they solved multiple-choice questions.

Results: Sixteen strategies were identified through the oral and written think-alouds that students used to solve MCQ. Eleven of these have been described and supported by the literature, while the rest were utilized by our students when solving MCQ in anatomy. Domain-specific strategies of visualizing and recalling had the highest use. Personal connection was a strategy that allowed students to achieve success in all ICE levels in the oral think-alouds and in the I and E levels in the written think-alouds.

Conclusions: This research argues that it is upon us as educators to make learning visible to our students, specifically through the use of think-alouds. It also raises awareness that when educators facilitate the process of students making personal connections, it aids students in new knowledge being integrated effectively and retrieved accurately.