PurposeAssessment of the Core Entrustable Professional Activities for Entering Residency (Core EPAs) requires direct observation of learners in the workplace to support entrustment decisions. The purpose of this study was to examine the internal structure validity evidence of the Ottawa Surgical Competency Operating Room Evaluation (O-SCORE) scale when used to assess medical student performance in the Core EPAs across clinical clerkships.

Background Analytic thinking skills are important to the development of physicians. Therefore, educators and licensing boards utilize multiple-choice questions (MCQs) to assess these knowledge and skills. MCQs are written under two assumptions: that they can be written as higher or lower order according to Bloom’s taxonomy, and students will perceive questions to be the same taxonomical level as intended. This study seeks to understand the students’ approach to questions by analyzing differences in students’ perception of the Bloom’s level of MCQs in relation to their knowledge and confidence. Methods A total of 137 students responded to practice endocrine MCQs. Participants indicated the answer to the question, their interpretation of it as higher or lower order, and the degree of confidence in their response to the question. Results Although there was no significant association between students’ average performance on the content and their question classification (higher or lower), individual students who were less confident in their answer were more than five times as likely (OR = 5.49) to identify a question as higher order than their more confident peers. Students who responded incorrectly to the MCQ were 4 times as likely to identify a question as higher order than their peers who responded correctly. Conclusions The results suggest that higher performing, more confident students rely on identifying patterns (even if the question was intended to be higher order). In contrast, less confident students engage in higher-order, analytic thinking even if the question is intended to be lower order. Better understanding of the processes through which students interpret MCQs will help us to better understand the development of clinical reasoning skills.

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This article offers insights into students’ perceptions of writing through the use of drawings and written responses. In a descriptive qualitative study of fifth graders across two diverse elementary schools, students were prompted to draw a picture about a recent experience with writing and how that experience made them feel. Students were then asked to write a description of their drawings. We studied features in the drawings and written responses and constructed four thematic categories. Findings highlight the range of both positive and negative experiences with writing as well as a realistic tool for literacy teachers to use to take the temperature of the classroom.