Royal College of Surgeons in Ireland
e-publications@RCSI
Anatomy Conference Proceedings and Posters
Department of Anatomy
1-1-2013
Is a picture worth a thousand words?
Jane C. Holland
Royal College of Surgeons in Ireland, [email protected]
Robin O'Sullivan
RCSI-Medical University of Bahrain
Richard Arnett
Royal College of Surgeons in Ireland
Citation
Holland JC, O'Sullivan R, Arnett R. Is a picture worth a thousand words? A poster presentation at the Association for Medical
Education in Europe 2013, Prague, Czech Republic. Royal College of Surgeons in Ireland, Dublin: 2013.
This Conference Poster is brought to you for free and open access by the
Department of Anatomy at e-publications@RCSI. It has been accepted for
inclusion in Anatomy Conference Proceedings and Posters by an
authorized administrator of e-publications@RCSI. For more information,
please contact [email protected].
— Use Licence —
Attribution-Non-Commercial-ShareAlike 1.0
You are free:
• to copy, distribute, display, and perform the work.
• to make derivative works.
Under the following conditions:
• Attribution — You must give the original author credit.
• Non-Commercial — You may not use this work for commercial purposes.
• Share Alike — If you alter, transform, or build upon this work, you may distribute the resulting work only
under a licence identical to this one.
For any reuse or distribution, you must make clear to others the licence terms of this work. Any of these
conditions can be waived if you get permission from the author.
Your fair use and other rights are in no way affected by the above.
This work is licenced under the Creative Commons Attribution-Non-Commercial-ShareAlike License. To
view a copy of this licence, visit:
URL (human-readable summary):
• http://creativecommons.org/licenses/by-nc-sa/1.0/
URL (legal code):
• http://creativecommons.org/worldwide/uk/translated-license
This conference poster is available at e-publications@RCSI: http://epubs.rcsi.ie/anatproc/2
Is a picture worth a thousand words?
Holland
Departments of Anatomy
1
JC ,
1RCSI-Dublin
&
O’Sullivan
2
R,
2RCSI-MUB, 3QEO
Arnett
RCSI-Dublin
Context:
Results:
While the use of appropriate illustrations in learning has been shown to
facilitate understanding and increase information retention, particularly for
delayed recall1,2, information on the effect of illustrations in examinations
is more limited. However, it is suggested that the use of illustrations in
assessment has variable effects on individual items3.
We analysed 195 single best answer MCQs; 95 used text alone and 100
used illustrated text. The number of students per examination ranged
from 277 to 347, with a total of 60,850 student-question interactions. Q-Q
plots were performed of all data to identify distribution (SPSS v20, IBM
Corporation).
There was no difference in item difficulty between the two groups
Objectives:
This study examines the effect of illustrated text, as opposed to text
alone, in Multiple Choice Question (MCQ) vignettes to discern if any
significant difference in item performance between the two formats is
detectable in an undergraduate histology examination.
(0.76 vs. 0.80; p = 0.862, Mann-Whitney-U; Figure 3).
Methods:
Histology within RCSI is taught during the 1st medical year, though 12
online modules, or SCORMs (Sharable Content Object Reference
Model). Six modules are taught within the first academic semester, and
6 within the second. Histology is then assessed at the end of each
semester by means of summative examination: the semester 1
examination contains 30 multiple choice questions, the semester 2
examination contains 35.
We reviewed 6 Histology MCQ examinations from our Medical Junior
Cycle (1st medical year). All items were in single best answer (SBA)
format with 5 options, and statistics regarding item performance were
obtained following each examination using classical test theory analysis4
(Speedwell, Cambridge, UK).
Figure 3. Item Difficulty
Item discrimination, as measured by point biserial correlation, also
showed no significant difference between the two groups (0.305 vs.
0.304; p = 0.948; Independent t-test; Figure 4).
Items were then divided into two groups, depending on whether their
vignettes used text alone (TA) or illustrated text (IT). Both TA and IT
MCQs were used to either basic recall, or higher levels of cognition such
as understanding and application of knowledge. Examples of MCQs from
each group may be seen in Figures 1 & 2.
Figure 4. item discrimination
Discussion:
Figure 1. Items assessing
basic recall
Figure 2. Items assessing
Understanding or application
3
R
We found no significant difference in item difficulty or discrimination
resulting from the addition of illustrations to Single Best Answer MCQs.
With text-alone MCQs, the decision as to whether to use context-free or
context-rich stimulus formats depends on whether simple factual
knowledge or higher-level reasoning is being assessed5. Our data
suggest that both textual vignettes and those with illustrations are valid
formats for undergraduate histology examinations. Individual items in
either format are capable of testing either basic recall or more complex
reasoning.
References:
1. Levie WH, Lentz R. Effects of text illustrations: A review of research. ECTJ. 1982 1982/12/01;30(4):195-232.
2. Carney R, Levin J. Pictorial Illustrations Still Improve Students' Learning from Text. Educational Psychology Review. 2002 2002/03/01;14(1):5-26.
3. Vorstenbosch MATM, Klaassen TPFM, Kooloos JGM, Bolhuis SM, Laan RFJM. Do images influence assessment in anatomy? Exploring the effect of
images on item difficulty and item discrimination. Anatomical Sciences Education. 2013;6(1):29-41.
4. Engelhardt PV. An Introduction to Classical Test Theory as Applied to Conceptual Multiple-choice Tests. Getting Started in PER, edited by C Henderson
and KA Harper (American Association of Physics Teachers, College Park, MD, 2009), Reviews in PER. 2009;2.
5. Schuwirth LW, van der Vleuten CP. Different written assessment methods: what can be said about their strengths and weaknesses? Med Educ. 2004
Sep;38(9):974-9.