Why Physician Assistant Students Need Practice Questions

Students use numerous study techniques in hopes of absorbing a significant amount of information in a short period of time. Ideally, they retain this information for the long haul to apply clinically and practically in the real world.

But not all study techniques are created equal. One study looked at 10 commonly used study techniques. These included summarization, highlighting, keyword mnemonic, practice testing, imagery use for text learning, rereading, distributed practice, elaborative interrogation, self-explanation and interleaved practice.

They found practice testing and distributed practice were the most effective. Distributed practice, which is studying over multiple sessions instead of cramming everything in the night before, not surprisingly resulted in better long-term knowledge retention.

The study also found that practice testing with feedback is better than practice test alone.

Again, none of this sounds shocking but many students in PA school are hard-pressed for time and responsible for an exorbitant amount of information. That’s why one of my focuses with All Things PA-C is to provide practice test questions for students to incorporate in their studies.

So how do we create good, quality practice questions conducive to learning?

The PANCE and PANRE exams are multiple choice, so it obviously makes since that practice questions should be too.

Multiple choice questions can be used not only to test knowledge but to facilitate learning. One fascinating study showed how well-designed test questions enhanced recall of information. However, a poorly worded question can have the opposite effect.

Questions should be simple. Answer choices like “A and B but not C” are not as conducive to learning. You spend more energy trying to break down the question format than recalling correct information.

“All of the above” and “None of the above” are also not optimal. With “none of the above”  you’re not recalling correct information.

Questions, as much as possible, should be “real world” centered. For example, knowing the difference between how two disease states would present might be asked “which symptom favors COPD versus heart failure?”

Or you’re given a symptoms and must come up with the diagnosis. “An elderly patient presents with progressively worsening shortness of breath and a pansystolic murmur. What is the most likely diagnosis?” Questions like this allow you to apply the knowledge in a real world setting.

Questions should offer a few responses that are reasonable choices with one being the “most correct.” Too many “close” answers make the question confusing and you’re not as likely to learn. As most questions on the PANCE have 5 answer choices, a format I like to use is one “most correct” choice, two plausible choices, one incorrect option, and one that is definitely wrong or potentially harmful. This can be especially helpful if you read the explanations behind why which answer is correct or incorrect. You glean as much from the wrong answers as you do the correct ones.

A test shouldn’t be too difficult. Answering too many questions incorrectly can increase the memory of wrong information. This doesn’t mean make the test easy, a test should judge how well takers know the material. If the majority of students miss a question, it’s probably a bad question. There’s an entire detailed process for determining the appropriate number of correct answers to pass the PANCE. And although no one that I know of would call the test easy, a large majority of first-time takers will pass.

Butler AC. Multiple-Choice Testing in Education: Are the Best Practices for Assessment Also Good for Learning? Journal of Applied Research in Memory and Cognition. 2018;7(3):323-331. doi:10.1016/j.jarmac.2018.07.002.

Dunlosky J, Rawson KA, Marsh EJ, Nathan MJ, Willingham DT. Improving Students’ Learning With Effective Learning Techniques. Psychological Science in the Public Interest. 2013;14(1):4-58. doi:10.1177/1529100612453266.

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