Integration of basic science and clinical concepts is a key goal during undergraduate training as it promotes novices’ clinical reasoning. While teaching methods for integration have evolved through research and practice, assessment methods to support integration are still underdeveloped. Integrated teaching maybe negated if assessment is not aligned to promote integrated understanding. Furthermore, novel developments in assessment theory suggest that assessments can enhance educational outcomes – a phenomenon known as test-enhanced learning. The following proposal will develop integrated multiple-choice questions (MCQs) and short answer key feature (KF) tests and examine if testing with these tools enhances integration of basic science and translates to improved clinical reasoning.
First and second year medical students (n=80) will be exposed to teaching on four disorders in rheumatology. Subsequently, they will be exposed to test-enhanced learning in one of four conditions: with MCQ or KF; with integrated or unintegrated formats. Integration in MCQs will be achieved by pairing basic science and clinical questions; integrated KFs will query basic science mechanisms prior to clinical questions. One week after the test-enhanced learning, participants will return to complete a transfer test where they will diagnose written cases and 16 videos of standardized patients. Participants will also complete a concept sorting of clinical cases to determine if their schemas for clinical reasoning incorporate basic science mechanisms.
We anticipate no difference between the MCQ and KF formats. However, we expect participants in both formats exposed to integrated test-enhanced learning to have higher accuracy in diagnosis of SPs and that their concept sorting of cases will use basic science based structural similarity instead of superficial features. The results will inform how the integration of basic science can be augmented and furthered by a rigorous assessment process.