The Educational Effects of a Summative Diagnostic Reasoning Examination Among Second-Year Medical Students Article

Lupi, CS, Tempest, HG, Ward-Peterson, M et al. (2018). The Educational Effects of a Summative Diagnostic Reasoning Examination Among Second-Year Medical Students . 28(4), 667-673. 10.1007/s40670-018-0610-x

cited authors

  • Lupi, CS; Tempest, HG; Ward-Peterson, M; Ory, SJ


  • The medical education literature is beginning to address the educational effects of summative closed-response (MCQ) and open-response (short answer) exam formats. This study examines the student-reported educational effects of these types of testing. From 2013 to 2016, an open-response summative “diagnostic reasoning examination” (DxRx) has been administered in the Reproductive Systems Module. The DxRx consists of unfolding cases requiring short answers and a final explanation of pathophysiology. The module also utilizes an NBME MCQ examination. Annually, the authors have queried students on their preparation for these examinations in post-course surveys. Narrative responses were categorized using three domains from a validated framework: cognitive processing, resources, and content. The average survey response rate was 72.5% (n = 343). The percentage indicating their study strategy for the DxRx differed from the NBME exam ranged from 81.6 to 97.9%. Ninety percent of respondents provided comments. On cognitive processing, 38% reported re-organizing course content by clinical presentation (rather than studying disease in isolation), 18% described developing and/or practicing generation of differential diagnoses, 14% reported shifting to group study. Students reported using case-based material and focusing on content directly related to clinical problem-solving. Ten percent of students volunteered metacognitive insights suggesting more robust learning from DxRx preparation. The majority of students reported different approaches to studying for the DxRx that support constructing new knowledge and the cognitive skills required for clinical problem-solving. We believe these findings represent an important step in exploring the educational effect of these two types of summative testing.

publication date

  • December 15, 2018

Digital Object Identifier (DOI)

start page

  • 667

end page

  • 673


  • 28


  • 4