Short and long multiple-choice question stems in a primary care oriented undergraduate medical curriculum.

In this study Year 1 students in a new, primary care-oriented undergraduate course were offered a practice multiple-choice question (MCQ) examination with two question item formats--with and without brief primary care-based clinical scenarios--with the same correct answers. Data collected included: completion time; number correct; and responses to a questionnaire seeking student perception on the time required, clarity, ease of choice, and curriculum relevance. The mean scores for both groups of students were no different, although about 20% more time was required to complete clinical scenario stem question sets. Students perceived that the clinical scenarios had little effect on choosing the correct answer, improved question clarity and increased relevance to the curriculum. This study suggests that it is possible to assess junior medical students studying integrated undergraduate medical curricula by using MCQs containing brief clinical scenario stems, so long as either item numbers or timing are adjusted. This item format better reflects the learning process and may better prepare students for later professional practice assessment. GPs have an important role in developing assessment items that reflect early clinical integration.