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anatomy self-assessment tests
classic EMQ paper format
narrative - hormonal regulation
free text - bacterial chemotaxis
check boxes - colonic functions
quantitative - experimental design
graphic input - metabolic pathways
free format - clinical case studies
conclusions - a possible way forwards
We have been using EMQs in Leeds for medical teaching for the last ten years, so several of the following examples are drawn from the "Nutrition & Energy" course, and also from BIOC2120 which was designed around the same time. They seem equally suitable for other disciplines, and lend themselves to computer evaluations, using websites with HTML forms.
We run a computer practical in ICU3 on basic cross sectional anatomy that medical students will need to interpret CT and MRI scans. These tests provide some practice drill. Click the drop-down menus for response options, then click the submit button when done. The feedback level is adjustable from (i) basic marks, (ii) identify the mistake, or (iii) provide the correct answer. [If you decide to change the feedback level, you must press the 'Submit' button again to re-run the test.] This question-setting technique will work with any graphic image: histology or species identification for example, electron micrographs, metabolic pathways, or molecular biology cartoons. Click here for some more tests - these were really easy to set up!
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The classic EMQ format is built around a theme, which in the following example is the gene family "SLC25" whose protein products are plugged through the mitochondrial inner membrane. The logical necessity for this group of transport proteins was famously predicted by Peter Mitchell in the mid 1960's, several years before their existence was eventually demonstrated in the laboratory. For a recent report, please see Haitina, T et al (2006) Fourteen novel human members of mitochondrial solute carrier family 25 (SLC25) widely expressed in the central nervous system. Genomics 88(6), 779-790.
The theme is introduced by a lead-in which is followed a list of up to twelve options:
For each of the processes listed below, select the mitochondrial inner membrane carrier system which is most likely to be involved. Each option may be used once, more than once, or not all.
oxoglutarate / malate carrier
carnitine / acylcarnitine translocase
adenine nucleotide translocator
glutamate / aspartate carrier
The options are followed by up to five questions that all share the same option list.
Distractors are the plausible but incorrect statements included as alternative choices in a traditional MCQ. It can be difficult to choose good distractors, and for formative tests students sometimes remember the best distractors in preference to the correct answer! For EMQs the valid answers to the other questions in the same set usually make excellent distractors. EMQs need not contain ANY false statements and are much more difficult to guess.
It is sometimes claimed that EMQs are more difficult to compose than MCQs, although good MCQs can be very difficult to write. This seems to be more a question of familiarity than inherent difficulty, because it has not proved difficult to generate a wide variety of formative EMQs for medical teaching, or for the BIOC2120 course.
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Paper versions of EMQs normally share the same set of options, and this may be an advantage where there is stong linking theme. There is, however, no need for this restriction when the questions are completed on screen. For convenience, the next set of questions are gathered together at the end, but they could easily have been dispersed through the text. The following "urban myth" explores a range of physiological adjustments. The options vary from one question to the next.
A young woman lies asleep dreaming of a holiday abroad. Her bed is warm and comfortable but she stirs slightly in the small hours as the sky begins to lighten and her stomach reminds her that it is almost time for breakfast.
Suddenly she awakes and looks at the clock. "Oh ****!" she says, and leaps from the bed, frantically pulling on her clothes. Skipping breakfast and her morning shower she races from the house and sprints for the bus stop at the far end of her street. She makes the bus with seconds to spare and collapses on a seat to regain her breath.
By the time she gets to work about 30 minutes later she has almost recovered her composure. She puts her head round the bosses door: "I missed breakfast, but have I time to do my hair before the interview?"
"It's okay" says the bosses secretary "he's rung in sick. You can get your breakfast in the staff canteen."
By this stage she is really hungry, and orders poached eggs on toast with sausages and baked beans, washed down with a big mug of coffee, and some more toast and marmalade. As she settles down to read the newspaper, she realises that she needs to visit the loo...
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This is based on the article by Wadhams & Armitage (2004) Nature Reviews Molecular Cell Biology 5, 1024-1037. This somewhat prolix example is a little repetitious and intended for formative use. It describes the functions of the enzymes and asks the students which is which, but it is equally possible to name the enzymes and ask instead what they do. A summative version could be much shorter than this example.
Reprinted by permission from Macmillan Publishers Ltd: Wadhams GH & Armitage JP (2004) "Making sense of it all: bacterial chemotaxis" Nature Reviews Molecular Cell Biology 5, 1024-1037, fig. 2 copyright 2004. License number 2327540163221