What is the Right Answer?

This is an article I wrote for EMS World some time ago—but it is as relevant now as it was then. As we integrate pathophysiology and expect our students to think more and more in clinical practice, solid exam questions are foundational. A solid exam not only measures student’s knowledge but sets an expectation of the level we want them to learn. My good friend Joe Mistovich says this: “If you want your students to learn superficially, test superficial information. If you want them to learn comprehensively, you must test comprehensively.” Please take a moment for some test question basics.

Written testing is an issue that causes considerable stress for both students and instructors. Students want to pass the course. Instructors want to properly prepare their students for state final or National Registry examinations. This column looks at several common problems and issues in testing to help both instructors and students.

Testing beyond one chapter.

Problem:When creating exams many instructors only include materials from chapters currently being covered in class. In real life-as in final examinations-questions (and patients) will span the curriculum.

Solution: Include a few questions from previous chapters or classes. Warn your students in advance and explain that all the material they are learning fits together-and will be on the final.

Testing higher-level cognitive concepts.

If all our test questions look like this, we're in trouble:

29.There are_____cervical vertebrae
a. 3  
b. 5
c. 7  
d. 9

Problem: These lower-level cognitive questions require simple recall alone. Some are appropriate and to be expected. However, final exams will ask students to synthesize and integrate more than one concept from life-like field scenarios, which can be shocking to anyone who has never been exposed to them.

Solution: Use scenario questions that require students to pick out key information in order to come to a proper conclusion. These will likely include material from more than one class session or textbook chapter. They may also require students to interpret and apply learned material.

An example of a scenario-based question is:

29. You have applied a non-rebreather mask to a patient who is complaining of difficulty breathing. The patient complains that the mask is "suffocating" her and that she "can't stand it." Which of the following is an appropriate FIRST step?

a. Switch to a nasal cannula with 6 liters per minute of flow.
b. Coach the patient on how to adjust to the non-rebreather mask.
c. Check to make sure the reservoir bag is not completely deflating when the patient breathes in.
d. Remove the mask for 15 seconds every minute to relieve the feeling of suffocation.

This question requires both prioritizing the responses (which would you choose first?) and troubleshooting the problem. A quick check of the bag for deflation would be an appropriate first choice. Then a student could coach or-in extreme cases that can't be resolved by coaching-switch to a cannula.

Testing beyond one perspective.

Problem: Students quickly become familiar with their instructor's exams: your style, wording or, in the case of questions culled from a test bank, the type of questions you will choose.

Solution: Ask another instructor to prepare an exam for you. Return the favor for them. If you are worried about their test covering things you didn't or shocking your students-good! It will lessen the shock for them on the final and Registry exams. It may also let students know it's their responsibility to study and learn-not just listen.

Teaching students to search beyond the "right answer" to find the "most correct" one.

Problem: One of the most common statements made by students coming out of the NREMT exam is "Some of those had no right answer!" Not true, but it might seem that way. Students are handed a lot of "grounders" in class exams. These are questions with one correct answer that stands out far above the rest.

Right answers shouldn't always jump out at your students. It isn't always the "right answer" an EMT is looking for, it's the "most correct" one. And there is a difference. This might be why some of my marginal students pass the NREMT while some of the best fail. The better students freak out (using a student term) because they can't find the perfect answer.

Solution: Vary your test questions. They can't all be grounders. While there will be some discourse (aka whining), use it as a chance to teach students the fine art of test-taking-and how to choose the most correct answer. You will also create a teachable moment within that discourse: When students are looking at you wanting an explanation, they are open and ready to learn-and to remember!

This last point synthesizes all the others. Creating exams that serve both you and your students well are challenging and time consuming to create. They often produce spirited classroom conversations that are not easy either. But they're as worth the time and investment you put into them as your students are.

Question of the Quarter
Some educators teach students to don gloves before ever reaching the patient. Others advocate making BSI (body substance isolation) choices based on the situation.

Have you ever had a student ask why doctors and nurses in the medical office setting rarely wear gloves? Do you teach your students to wear gloves on all calls or make a judgment based on the particular situation? Which do you feel is better? Most practical? Most safe?

Thanks to Melissa Alexander-Shook and Brady Publishing for question examples.