The use of multiple true/false and single-best-answer questions across the medical curriculum: strengths and limitations from an evidence-informed perspective
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Abstract
The adoption of Single Best Answer (SBA) and Multiple True or False (MTF) questions in the assessment of medical students within an Outcome-Based Education (OBE) framework continues to evolve toward competency-based training. This necessitated an urgent effort to evaluate the effectiveness of various assessment methods in fostering clinical reasoning, knowledge application, and decision-making skills.
The current viewpoint highlights the strengths and limitations of both SBA and MTF formats, emphasizing their suitability in different stages of medical education. While MTF questions offer broad content coverage and efficiency in assessing foundational knowledge in preclinical years, SBA questions are better suited for higher-order cognitive skills and real-world clinical decision-making in the later clinical years. The discussion underscores the necessity of a strategic combination of these formats to align with OBE principles, ensuring that medical graduates are well-equipped for professional practice.
This viewpoint is an attempt to provide insights for medical educators, curriculum designers, and policymakers seeking to refine assessment strategies in undergraduate medical training. By advocating for a balanced approach to assessment, the article contributes to ongoing efforts to enhance the validity, reliability, and effectiveness of medical examinations. This topic aligns well with the journal’s focus on medical education innovation and curriculum development, making it a timely and relevant addition to your publication.
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References
1. Chen G, Wang H, Zhou L, Yang J, Xu L, Liang Y. Development and applications of graduate outcome-based curriculum for basic medical education. Front Med (Lausanne) 2024;11:1400811. https://doi.org/10.3389/fmed.2024.1400811
2. Iqbal S, Willis I, Almigbal TH, Aldahmash A, Rastam S. Outcome-based education: evaluation, implementation and faculty development. MedEdPublish 2020;9:121. https://doi.org/10.15694/mep.2020.000121.1
3. Krishnappa S, Das S, Raju K, Chaudhary N, Bevinakatti SH. Outcome-based medical education: implication and opportunities for competency-based medical education in undergraduate pathology. Cureus 2023;15(8):e42801. https://doi.org/10.7759/cureus.42801
4. Sheriff DS. Assessment methods in medical education. Ann SBV 2023;12(1):11-3. https://doi.org/10.5005/jp-journals-10085-9124
5. Brassil CE, Couch BA. Multiple-true-false questions reveal more thoroughly the complexity of student thinking than multiple-choice questions: a Bayesian item response model comparison. Int J STEM Educ 2019;6:1-17. https://doi.org/10.1186/s40594-019-0169-0
6. Montello MB, de Moura SB, Abreu BJ. Bloom's taxonomy as a tool for educational objectives applied to human anatomy. Morphologie 2025;109(364):100943. https://doi.org/10.1016/j.morpho.2024.100943
7. Somerville J. A personal perspective on philosophy of teaching: the clinical learning environment, teaching session and assessment. J Med Educ Curric Dev 2025;12. https://doi.org/10.1177/23821205241312824
8. Zegugu M, Chatoo SA, Choudhry A, Metezai H, Usman D, Kamal M, et al. Single best answer questions as a teaching tool in medical education: an international mixed-method comparative evaluation. Cureus 2024;16(9):e69745. https://doi.org/10.7759/cureus.69745
9. Rahim AF, Simok AA, Wahab SF. A guide for writing single best answer questions to assess higher order thinking skills based on learning outcomes. Educ Med J 2022;14(2):111-24. https://doi.org/10.21315/eimj2022.14.2.9
10. Norcini J, McKinley DW. Assessment methods in medical education. Teach Teach Educ 2007;23(3):239-50. https://doi.org/10.1016/j.tate.2006.12.021
11. Chandratilake M, Davis M, Ponnamperuma G. Assessment of medical knowledge: the pros and cons of using true/false multiple-choice questions. Natl Med J India 2011;24(4):225-8.
12. Schuwirth LW, Van Der Vleuten CP. Written assessment (ABC of learning and teaching in medicine). BMJ 2003;326(7390):643-6. https://doi.org/10.1136/bmj.326.7390.643
13. Gardner-Medwin T. Certainty-based marking: Stimulating thinking and improving objective tests. In: Bryan C, Clegg K (eds), Innovative Assessment in Higher Education: A Handbook for Academic Practitioners. 2nd Edition. 2019:pp141-50. Routledge, Taylor & Francis, London, UK. ISBN: 9780429506857. https://doi.org/10.4324/9780429506857
14. Awang Besar MN, Abd Aziz KH, Abdul Halim H. The validity of multiple-true-false and one-best-answer in the final professional undergraduate medical examination. Educ Med J 2025;17(2):5-21. https://doi.org/10.21315/eimj2025.17.2.2