Improve the Quality of Entrance Tests

The Board of professional Entrance examination (BOPEE) recently invited online applications from the candidates interested in appearing in the Entrance Test for admission to MD/MS/MDS/PG Diploma Courses 2016 in the Government Medical Colleges of Srinagar, Jammu, SKIMS-Srinagar, ASCOMS, and MDS Courses-2016 in the Govt. Dental College, Srinagar.
Improve the Quality of Entrance Tests
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The Board of professional Entrance examination (BOPEE) recently invited online applications from the candidates interested in appearing in the Entrance Test for admission to MD/MS/MDS/PG Diploma Courses 2016 in the Government Medical Colleges of Srinagar, Jammu, SKIMS-Srinagar, ASCOMS, and MDS Courses-2016 in the Govt. Dental College, Srinagar. There are a total of 278 seats for different streams for MD/ PG courses. Out of 278 seats, 95 seats are reserved for Govt. Medical College Jammu, 80 seats for Govt. Medical College, Srinagar, 103 seats for SKIMS and Acharya Shri Chander College of Medical Sciences, Sidhra, Jammu (ASCOMS). Besides these seats, there are 41 seats for PG diploma Courses, in which 31 seats are reserved for Govt. Medical College, Jammu, and 09 seats for Govt. Medical College Srinagar, 1 seat for SKIMS and 9 seats for ASCOMS, College, Jammu. Furthermore, 12 seats have been reserved for MDS courses for Srinagar.

These professional exams are presently conducted by the Jammu & Kashmir Board of Professional Examinations under Rules, 2014, MCI & DCI Regulations. The BOPEE has been constituted under the Jammu and Kashmir Board of professional entrance Examination Act, 2002 to conduct the free and fair entrance examination. Now the question arises whether the entrance tests, which are conducted through BOPEE since long, are absolutely fair or there are still loopholes in conducting these professional entrance tests. The   concept of fair examination does not mean here only that the questions papers must be remain top secret but it must be free and fair as per the international norms. By fair we also mean whether paper setters who frame the question papers for different streams are reputed medical professionals and practitioners in their respective steams. This is important for genuine assessment of medical students and junior doctors for universities and accredited colleges. The question arises whether the higher authority at the helm of affairs will ever make BOPEE and paper setters accountable for not following the standard national and international norms to assess the genuine ability of the candidates? No such commission or committee has been framed till date to monitor or improve the standard of entrance examination. By simply writing a few multiple-choice questions (MCQ"s) in one's area of specialty will not suffice. Any examination should be fair, valid and reliable. 

Dianne E Campbell from university of Sydney published his research paper in "journal of pediatrics   and child" (Royal Austraiasian college of Physicians) on how to write good multiple-choice questions to eliminate those students who follow the strategies to guess correct answers in poorly written multiple choice questions. These questions are a newer form of MCQ type questions that are used in some universities in Australia, Canada and the UK as part of medical student assessment. They are written in short scenario form with a series of pieces of additional information with which the candidate must determine whether these pieces of information make a statement or diagnosis which is more or less likely. They have a complicated grading system, which relies on a score derived from a panel of experts, with no absolute incorrect or correct answers. They are more difficult to write than conventional MCQ questions. 

The most commonly used form of MCQs used in science, medicine and postgraduate medical assessment is Single Best Answer (SBA). These questions are often constructed in scenario form, with an introductory 'stem', which sets the clinical scenario, a lead-in question such as; which one of the following as the most likely diagnosis?, and the list of five possible responses  consisting of four 'distractors'  and one correct answer. These are sometimes referred to as 'A' type MCQ's. They may test only 'fact recall' in their most basic form; however, when written as a clinical scenario, they often test the ability to synthesize information and to some extent clinical reasoning. Another form is called extended matching questions (EMQ). EMQ's are increasingly used a medicine and sciences examination. They are relatively easy to write, have evidence for good discrimination between students' abilities and have been shown to be superior to standard SBA (Single Best Answer) in assessment of clinical reasoning. They are typically structured in a theme with a list of possible options (usually 8-10). Most of medical students used correct options on the basis of the structure or working of the questions rather than on knowledge basis. Student's web based sites such as 'bored of studies' (http//www.boredofstudies.org/) have lists of tips on how to pass MCQ questions and are frighteningly accurate in what they perceive as best ways to eliminate poorly written distractors (incorrect options). Many candidates are aware of all elements that help to make poor or easily guessed questions. Inclusion of these elements will decrease the capacity of an examination to determine actual knowledge or ability of the candidate. To synthesize information and reduce the validity of the examination, a good single Best Answer (SBA), extended matching questions (EMQ) should be structured so that the correct response can be given by an expert or high performing candidate even if the options are covered up. When writing a question, always check that it passes this cover test. Preforming the cover test often identifies the presence of insufficient relevant information or ambiguities in the stem. In new recommended MCQ all the options must be keep homogenous. Options like all of the above, none of the above or options (c+d) must be avoided. True/false questions have no place in newly recommended international MCQs. 

It is very unfortunate that the BOPEE still follows their old pattern of MCQs and they don't try to improve the quality of entrance examinations in accordance with international norms. By following old pattern of MCQ's, they only help and accommodate candidates who don't deserve to be selected in sensitive professions where lives of people are at stake. 

Conclusion: The BOPEE must review their old policy and adopt international standards so that entrance test can differentiate between the standard and quality of candidates selected in medical profession. Moreover, competent Medical professionals and subject experts must be hired or consulted to review obsolete policy of framing MCQs. This will help ensure that best candidates are selected for this noble profession.

(Dr. Mohammad Afzal Bhat is a senior Researcher Officer at State Institute of Education, Srinagar.)
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