Comparison of level of cognitive process between case-based items and non-case-based items of the interuniversity progress test of medicine in the Netherlands

Dario Cecilio-Fernandes, Wouter Kerdijk, Andreas Johannes Bremers, Wytze Aalders, René Anton Tio

    Research output: Contribution to journalArticleAcademicpeer-review


    PURPOSE: It is assumed that case-based questions require higher order cognitive processing, whereas questions that are not case-based require lower order cognitive processing. In this study, we investigated to what extent case-based questions and questions that are not case-based, relate to Bloom's taxonomy.

    METHODS: In this article, 4800 questions of the Progress Test were classified whether it was a case-based question and the level of Bloom's taxonomy. Lower-order questions require students to remember or/and basically understand the knowledge. Higher-order questions require students to apply, analyze, or/and evaluate. A phi-coefficient was calculated to investigate the relations between the presence of case-based questions and the required level of cognitive processing.

    RESULTS: Our results demonstrated that case-based questions were measuring higher levels of cognitive processing in 98.1% of the questions. Of the non-case-based questions, 33.7% required a higher level of cognitive processing. The phi-coefficient demonstrated a significant moderate correlation between the presence of a patient case in a question and its required level of cognitive processing (phi-coefficient = 0.55, p<0.001).

    CONCLUSION: Medical teachers should be aware of the association between item formats (case-based versus non-case-based) and the cognitive processes they elicit in order to meet a certain balance in a test, taking the learning objectives as well as the test difficulty into account.

    Original languageEnglish
    JournalJournal of educational evaluation for health professions
    Publication statusPublished - 13 Dec 2018



    • cognition
    • comprehension
    • medical education
    • learning
    • memory
    • netherlands
    • problem solving

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