Unlocking Cognitive Potential: Validating Multiple-Choice Assessments for Higher-Order Cognitive Skills in Medical Education

Abstract

Background: Designing reliable and valid written assessments to test higher-order cognitive skills—especially clinical problem-solving—remains a challenge in medical education. This study aimed to evaluate the effectiveness of multiple-choice questions (MCQs) in assessing different levels of cognitive learning by applying statistical validation methods.

Methodology: Conducted in 2025 at the Department of Biochemistry, Burdwan Medical College, Burdwan, the study involved second-semester undergraduate medical students. MCQs were developed based on clearly defined educational objectives and categorized according to the level of cognitive skill they intended to assess: recall, data interpretation, and problem-solving. All questions underwent peer review to ensure quality. A total of 50 MCQs were used, 25 targeting recall, 15 on data interpretation, and 10 designed to test problem-solving.

Results: Each item was analyzed for difficulty, discrimination, and distractor effectiveness. The average percentage of correct responses was 80 % for recall, 52.9% for data interpretation, and 39.6 % for problem-solving questions. Statistical analysis using the Chi-square test revealed no significant difference between these scores, indicating that the MCQs were effective across different cognitive levels, including higher-order thinking.

Conclusion: Properly designed and peer-reviewed MCQs can serve as reliable tools for evaluating not just factual knowledge but also higher-level cognitive skills like interpretation and problem-solving in medical students.