Assessing the Difficulty and Long-Term Retention of Factual and Conceptual Knowledge Through Multiple-Choice Questions: A Longitudinal Study
Bibliographic record
Abstract
Purpose: Multiple choice questions (MCQs) are the mainstay in examinations for medical education, physician licensing, and board certification. Traditionally, MCQs tend to test rote recall of memorized facts. Their utility in assessing higher cognitive functions has been more problematic to determine. This work evaluates and compares the difficulty and long-term retention of factual versus conceptual knowledge using multiple-choice questions in a longitudinal study. Patients and Methods: We classified a series of MCQs into two groups to test recall/verbatim and conceptual/inferential thinking, respectively. We used the MCQs to test a two-part hypothesis: 1) scores for recall/verbatim questions would be significantly higher than for concept/inference questions, and 2) memory loss over time would be more significant for factual knowledge than conceptual understanding compared with a loss in the ability to reason about concepts critically. We first used the MCQs with pre-clinical medical students on a summative exam in 2020, which served as a retrospective benchmark of their performance characteristics. After two years, the same questions were re-administered to volunteers from the same cohort of students in 2020. Results: Retrospective analysis revealed that recall/verbatim questions were answered correctly more frequently (82.0% vs 60.9%, P = 0.002). Performance on concept/inference questions showed a significant decline, but a larger decline was observed for recall/verbatim questions after two years. Performance on concept/inference questions showed a slight decline across quartiles, while two years later, recall/verbatim questions experienced substantial performance loss. Subgroup analysis indicated convergence in performance on both question types, suggesting that the clinical relevance of the MCQ content may have influenced a regression toward a baseline mean. Conclusion: These findings suggest conceptual/inferential thinking is more complex than rote memorization. However, the knowledge acquired is more durable in a longitudinal fashion, especially if it is reinforced in clinical settings.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.018 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".