The role of questioning is an important consideration to achieve any learning objective. Questioning seeks information (nefarious use is excluded here). Questions are tools used to unmask our minds functioning or evaluate how we are learning. Understanding questions is critical if we intend to give adequate answers.
Blooms’ Taxonomy
Blooms’ taxonomy or its later iterations may be considered to orient us as to how learning objectives and questioning fit. Three domains: cognitive, affective, and psychomotor, are the subject of questioning techniques used to evaluate whether a learning objective has been achieved. Each of these domains may be mapped to key functions or processes taking place in the brain.
Domains and Areas of the Brain Implicated
The cognitive domain of learning is considerably linked to the prefrontal cortex of the brain. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines six representative cognitive domains: complex attention, executive function, learning and memory, language, perceptual-motor control, and social cognition. The affective domain is emotion – based. Receiving, responding, valuing, organizing and characterizing are the identifiable skills by level of difficulty. The frontal lobe of our brain helps to manage our emotions with input or handshaking from our limbic system which is responsible for emotion and behavior modulation among other functions and include the amygdalae, the mammillary bodies, the hippocampus, among other areas. The psychomotor domain is based on the physical manipulation of an element of the environment, such as a tool; for example, a tape measure is used to measure abdominal perimeter. Manipulation of objects require motor control. Movement control or motor control of our bodies is achieved by the frontal lobe of the brain and fine tuning of this movement is achieved by the cerebellum. We should appreciate that any defect or reduced functioning of any area of our brain associated with processes involving with learning will affect optimal performance of the individual.
Question Order and Difficulty
The cognitive domain tends to be the focus of many examinations and we will highlight some aspects of questioning of this type briefly. Key questioning terms help direct us to the level of difficulty of a question. Lower order questioning terms which seek to measure knowledge and comprehension include but are not limited to define, state, what is, describe, or summarize. Higher order questioning terms which seek to measure application, analysis and interpretation include explain, analyze, interpret. Highest order questioning terms which seek to measure synthesis and evaluation include plan, design, develop, construct, make a judgement based on information acquired or presented.
Lower order questions
Fundamental to answering any question is the recall of some fact, set of facts, information, or procedure. Such questions are often categorized as lower order questions. The Mini-mental test that is used in medicine as a screening tool to alert the physician of possible cognitive decline or impairment, uses an item such as “What are the three objects you were told to remember?” to evaluate the patent’s ability to recall. Lower order questions may be referred to as the “easy questions”. However, memory of something, a fact, for example, depends on the abilities of the person trying to remember that fact (we may have isolated memory loss of an event but remain with normal intelligence, our abilities to make valued judgements or even learn new skills), and are neither easy nor trivial but simply fundamental.
Success for many academic disciplines may require mastering memorization of hundreds or even thousands of facts.
Higher order questions
Whereas the subsequent levels of questions, the higher order questions, depend on the use of memorized facts or information, the highest order of questions requires planning, designing, developing, creating something, synthesizing, or evaluating or making judgments about available evidence. Many memories of facts or information may be required to arrive at an adequate answer. Composite orders of questioning difficulty also exist. However, these require memory of dependent or independent facts or information to answer the given question adequately. Examinations whose intentions are to granularly separate examinees by their abilities are likely to use many composite higher order questions to achieve their desired goal.
Here is an example of a higher order composite question (HOCQ) that is likely present in of our Neurology – Embryology MCQ App as well as a lower order question (LOC) for comparison of the levels of difficulty involved.
HOCQ:
A 25-year-old primigravida enters your office for the first time with a severely disabled newborn. She had been diagnosed with bipolar disorder two years ago for which she has been taking a medication nightly. She takes no other medications and has no other significant medical history. She complains that her baby is wetting a lot of diapers daily. Which of these congenital abnormalities is most likely to be identified after physical examination and imaging studies of her offspring?
A. Chiari II malformation
B. Dandy-Walker malformation
C. Holoprosencephaly
D. Lissencephaly
Comment on HOCQ:
There are several higher order tracts present in this question. The answers from both must be correct to arrive at a final correct answer.
Tract 1: You must know that folic acid inhibitors are used to treat bipolar disease.
Tract 2: Also, you need to know that wetting of a lot of diapers is likely dysuria and polydipsia and caused by diabetes insipidus.
Tract 3: You need to link the previous determinations and make a conclusion that satisfies both tracks. A correct conclusion reads: a folic acid inhibitor, such as valproate, provoked failure of the anterior neural pore to remain open resulting in midline defects such as monoventricle and increased risk of pituitary dysfunction, as seen in the baby’s diabetes insipidus.
Tract 4: To finally answer the question, you must know or recall that holoprosencephaly is the only congenital abnormality option (option C), that is, the only midline defect characterized by failure of the anterior neural pore to close. No single fact or conclusion points to the diagnosis.
LOQ:
Cranial nerve associated with pain, tasting and swallowing:
A. VII
B. IX
C. X
D. XII
Comment on LOQ:
Whereas extensive reasoning was required for the HOCQ, there is no reasoning required for the LOQ. This is a simple recall question. You will have to remember that the answer is C (Cranial nerve X [CN X]).
We need to know the kind of questions are asked on any examination we plan to do. This should never be a secret. This is important because if you prepare for a recall centered examination and your actual exam is mainly based on higher order questioning, you will likely obtain a less than optimal exam score or even fail. So, prepare wisely. You should aim to practice using exams that closely reflect your actual examination if you intend to perform optimally.
[Words used here are directly related to their established meanings or what some may describe as the closest metaphor.]Dr. J. Richardson
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