Evaluation of the level of difficulty of patient cases for veterinary problem-solving examination: a preliminary comparison of three taxonomies of learning.

An important issue that has received insufficient attention in the use of problem-based learning in the medical curriculum is the mode of assessing the level of difficulty of patient cases. In the present study, the level of difficulty of case-based questions in a veterinary degree final examination in reproduction was evaluated. First, cognitive taxonomies were evaluated to clarify whether qualitative methods such as Bloom's taxonomy, the Structure of the Observed Learning Outcome (SOLO) taxonomy, and the Amsterdam Clinical Challenge Scale (ACCS) differed from each other as evaluation tools for problem-based cases. Using these taxonomies, 30 case-based questions from the final examination in reproduction in the Helsinki veterinary program were initially evaluated to determine which one was best suited to the evaluation of the difficulty of cases. In follow-up, the same cases were also evaluated by an experienced veterinary instructor in reproduction, with the aim of gaining insight into using these approaches to evaluating difficulty. It would appear, from this preliminary assessment, that the SOLO taxonomy may be the most suitable for evaluating the difficulty of patient cases, since the instructor's quality rating resembled more closely the SOLO than the Bloom taxonomy or the ACCS. It is to be emphasized that the purpose of this study was to provide a preliminary evaluation of possible approaches that might be used to assess patient-case difficulty. Resolving all issues will require a greater number of evaluations of all components.