Constructed Response Items as an Assessment Method for Undergraduate Medical Course: Improving the Validity

Written examinations are a predominant part of the assessment in Indian medical colleges and are used in the assessment of all types of learning or cognitive knowledge. Written tests are used to provide feedback and to measure the sufficiency of learning to proceed in the curriculum. It is best used to assess on "Knows" and "Knows how" of Miller's Pyramid. Traditional short- and long-essay items are not structured; there is no cross-checking of the set paper by the subject expert. There is a problem of undersampling or oversampling of content and items do not test the problem-solving abilities of students. Usually, questions are based on simple recall and knowledge is not tested in depth. Subjective scoring, rater bias, bluffing, flawed format, and idiosyncratic jargons are the other threats to the validity. This article describes the solutions to address limitations of traditional written examination based on the review of the current literature. Structuring long and short essay questions, preparing blueprint of the content, scoring rubrics, model answers, training the subject experts, and using multiple subject expert raters are the most important steps to address the validity threats and to make assessment more objective and focused. Uniform, bias-free assessment boosts confidence and results in positive impact on the academic performance of students.