How do students approach multiple choice questions: A secondary analysis of post exam reflective writings by physiology students

Background: Completing multiple choice questions are a fact of life for undergraduate students. MCQ exams are necessary to evaluate large size classes of 100 or more students. MCQ testing skills are questions is useful information to advise students on how to alter their test taking approaches for greater success. Purpose: This study is a secondary analysis of data collected during the 2015-2016 academic year a two semester Clinical Physiology course series. In this course series, students wrote reflective essays after taking two stage collaborative exams. The purpose of the original study was to determine if reflective writings would improve student exam scores. The purpose of the secondary analysis was to characterize student approaches to individual and collaborative exams consisting of multiple-choice questions. Methods: Students were asked to write essays on three exam questions after taking a two-stage collaborative exam. In a two-stage collaborative exam, student complete an exam individually and then complete the same exam in a group; students discuss each question until they reach consensus on each answer. For their reflection assignment, student chose 3 challenging questions and wrote about how they choice their individual answer, how their group reached the group answer and any insights they learning about testing process. Students’ writings were organized into individual thought processes, group thought processes and any thought processes. The entire corpus of the writing was read as a whole. Then the investigators assigned the following themes to the texts: individual approaches, types of mistakes and group approaches. Results: The most common way students chose their individual answers were 1) recall, 2) process of elimination, 3) gut reactions and 4) reasoning with basic principles. Common types of mistakes include answer based on a misconception, miscomprehension of the question, math or unit errors and conflicts between clinical experience and basic science principles. Students benefited from group discussions because group members were able to reframe a question, supply a missing piece to the solution or explain the mechanism of a physiological process. Students discover their own misconceptions and correct them immediately after an individual exam. As a result, a group of students can score higher on an exam than any individual students. However, groups did not always use mechanistic reasoning or basic principles. Often students resorted to voting on the most popular answer or choosing an answer advocated for by a confident student. Conclusion: Collaborative exams are beneficial to students because they are exposed to different ways of problem solving and reasoning in way that allows students if identify their own misconceptions and engage in deep learning with peers. However, students often use combinations of process of elimination and recall to answer questions. These results suggest an opportunity to encourage students to use basic science principles and mechanistic reasoning on exams for improved testing outcomes. This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.