7/8/2009
Batchelor, Osborn, Biel and Wieting
Higher-Order Learning involves
the mental processing of
content in ways that enable
learners to use it in the
performance of increasingly
complex cognitive tasks.
While there are several learning models,
Blooms Taxonomy is among most
accepted and practically useful.
In order to teach its students to
“think like physicians,” DCOM
must consistently promote
and assess higher-order
learning.
DCOM’s program objectives and
activities clearly reflect this need.
` Written
exams
` Case studies/lit reviews/portfolios
` Simulations/Demonstrations
l
` Observations
` Case presentations
` Written multiple choice questions
Writing multiple-choice
questions that effectively
measure higher-order learning
is difficult.
Within the realm of medical
education, scenario-based
questions are most useful in
that they can set up “authentic”
cognitive tasks.
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A 47-year old male presents to the
emergency department with a high fever,
chills, nausea, stiff neck and severe
headache. A Gram stain of cerebrospinal
fluid revealed the presence of a Grampositive coccus. What is the most likely
etiology?
A) Corynebacterium diphtheriae
B) Moraxella catarrhalis
C) Neisseria meningitidis
D) Staphylococcus aureus
E) Streptococcus pneumoniae
What is the most likely stage of
bereavement the father is in?
A) Acceptance
B)) Anger
g
C) Bargaining
D) Denial
E) Depression
After allowing them to express their
feelings, the family physician makes a
referral for both supportive and marital
counseling. Which would be the best
medication to prescribe for them both to
provide expeditious relief?
A) escitalopram (Lexapro)
B) fluoxetine (Prozac)
C) quitiapine (Seroquel)
D) venlafaxine (Effexor)
E) zolpidem (Ambien)
A young couple presents to their family physician six
weeks after losing their 4 month old son to a “crib
death.” The mother awoke early one morning to
check on her baby to find he had died during the
night. Both parents are devastated but seem to be
struggling toward recovery. They both report
increasing marital tensions and describe persistent
initial insomnia, daytime lethargy, and irritability.
The husband tries to reassure his wife that “things
are going to be okay and we should try to have
another child as soon as possible.” His wife finds her
husband’s suggestions aggravating and absurd. She
makes a number of statements beginning with, “If
only I had…..” Neither demonstrates nor endorses
any neurovegetative indications.
What is the most likely stage of
bereavement the mother is in?
A) Acceptance
B) Anger
C) B
Bargaining
i i
D) Denial
E) Depression
1.
2.
3.
4.
5.
Define content & level of
learning you wish to test
(question objective)
C
Create
scenario
i
Write question stem
Write distracters
Review and revise
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Prototypical cases
versus
“Authentic” cases
The question stem sets
up the cognitive task.
Tasks should model thinking
processes that physicians
have to be able to perform.
Using a “prototypical” scenario
involves only application.
Using an “authentic”
“
h
” scenario
involves application through
evaluation.
An 18 year old male presents to his physician
with dysuria and a yellow mucopurulent
urethral discharge. A Gram-negative coccus
is observed on a Gram-stain of the urethral
discharge. What is the outermost layer of the
cell wall a Gram-negative organism?
A) capsule
l
B) cytoplasmic membrane
C) lipopolysaccharide layer
D) peptidoglycan
E) S-layer
`
`
`
`
`
What is the most likely diagnosis?
What is most appropriate next step in
treatment?
Which medication would represent the
b
best
treatment option?
i ?
Which lab test would confirm the
probable diagnosis?
What is the most likely cause of her
neurological symptoms?
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Does the question stem
require one, two or
possibly more steps in
reasoning?
` Length
` Succinct
` Clearly
worded
` Plausible distracters
` Avoiding clues
The benefits of
collaboration
ll b
ti
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