• F Cohen Aubart, R Lhote, A Hertig, N Noel, N Costedoat-Chalumeau, A Cariou, G Meyer, F Cymbalista, N de Prost, P Pottier, L Joly, O Lambotte, M-C Renaud, C Badoual, M Braun, O Palombi, A Duguet, and D Roux.
• Service de médecine interne 2, hôpital Pitié-Salpêtrière, centre national de référence maladies systémiques rares et histiocytoses, Sorbonne université, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France. Electronic address: fleur.cohen@aphp.fr.
• Rev Med Interne. 2021 May 1; 42 (5): 302-309.

IntroductionIn France, at the end of the sixth year of medical studies, students take a national ranking examination including progressive clinical case-based multiple-choice questions (MCQs). We aimed to evaluate the ability of these MCQs for testing higher-order thinking more than knowledge recall, and to identify their characteristics associated with success and discrimination.MethodsWe analysed the 72 progressive clinical cases taken by the students in the years 2016-2019, through an online platform.ResultsA total of 72 progressive clinical cases (18 for each of the 4 studied years), corresponding to 1059 questions, were analysed. Most of the clinical cases (n=43, 60%) had 15 questions. Clinical questions represented 89% of all questions, whereas basic sciences questions accounted for 9%. The most frequent medical subspecialties were internal medicine (n=90, 8%) and infectious diseases (n=88, 8%). The most frequent question types concerned therapeutics (26%), exams (19%), diagnosis (14%), and semiology (13%). Level 2 questions ("understand and apply") accounted for 59% of all questions according to the Bloom's taxonomy. The level of Bloom's taxonomy significantly changed over time with a decreasing number of level 1 questions ("remember") (P=0.04). We also analysed the results of the students among 853 questions of training ECNi. Success and discrimination significantly decreased when the number of correct answers increased (P<0.0001 both). The success, discrimination, mean score, and mean number of discrepancies did not differ according to the diagnosis, exam, imaging, semiology, or therapeutic type of questions.ConclusionProgressive clinical case-based MCQs represent an innovative way to evaluate undergraduate students.Copyright © 2020 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.

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