Testing that Makes You Think: Development of a Basic Science Test to Promote Future Clinical Learning.

Introduction: Testing prior knowledge has been found to enhance learning new, related information. In this paper, we report on the development of a multiple-choice question (MCQ) test of basic science knowledge designed to elicit a particular kind of cognitive processing-distinctive processing-that, we argue, may be beneficial to future learning and clinical reasoning. Distinctive processing entails noticing both similarities and differences among concepts or entities. The recruitment and distinctive processing of prior basic science knowledge may optimally prepare learners to understand, remember and apply new, related clinical information. Methods: We developed two versions of a 19-item basic science MCQ. Both versions of the test had identical stems and correct response options; one version had very similar, plausible or "competitive" incorrect response options while the other version had less similar or "non-competitive" incorrect response options. We hypothesized that the "competitive" test version would elicit more distinctive processing than the "non-competitive" version. We conducted a concurrent verbal protocol to assess the response processes elicited by the two different test versions. Results: We found that the MCQ items designed with competitive or plausible incorrect answer options elicited more distinctive processing than MCQ items with less competitive or less plausible incorrect response options. Discussion: We showed that tests can be designed to promote cognitive processes that may be beneficial for future learning and that concurrent verbal protocols can be used to collect response process validity evidence for formative tests.