Use of multiple choice questions to assess the knowledge and awareness about HIV/AIDS-A core competency, among first and second MBBS students of KBNIMS, Gulbarga

Introduction: Multiple choice questions (MCQ’s) are a reliable and an efficient method of assessment. It is an objective type of assessment where, its efficiency depends on the item and the options given. A well framed MCQ is a very good tool for formative and summative assessment of the student. It is also been introduced in medical education, different entrance exams. The student can be assessed for the depth of the knowledge he/she has using MCQs. Also, the MCQs are less time consuming, cost effective and efficient and reliable. Aim and Objective: To compare the knowledge and awareness about HIV/AIDS in 1st and 2nd MBBS students using MCQs as an assessment method Materials and Methods: The study comprised 100 1st MBBS and 100 2nd MBBS students from KBNIMS, Gulbarga. Students were given 14 MCQs on HIV/AIDS and were asked to tick the correct answers. Results: In our study we found that the performance of 2nd MBBS students was better compared to 1st MBBS students in majority of the MCQs Conclusion: In this study we found that MCQs can be used as assessment tool to compare the knowledge and awareness about HIV/AIDS among UG medical students. We found that the knowledge and awareness of AIDS is better among 2nd year students who have the topic as core competency to learn. © 2020 Published by Innovative Publication. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by/4.0/)


Introduction
The ultimate aim of medical education is to improve the health and the health care of the population. 1 The outcomes of all medical education programs, in general, are focused on this aim. So assessments become necessary to measure accurately the students' progress towards achievement of this outcome. 1,2 Test with multiple choice questions (MCQ) and analyzing their options have become the choice of many examiners in medic al colleges. 1,3 Multiple-choice questions (MCQs) are one of the popular and accepted means of evaluation in medical education. MCQ test items are advantageous as they can cover wider section of lessons and scrutinize large numbers of students in lesser time simultaneously. The tests can be employed for both paradigms of assessment (formative and summative). Colleges are incorporating MCQs tests in their examinations as there is rising trend of adopting MCQs for postgraduate medical entrance examinations. Its acceptance is based on its objectivity, feasibility, high internal consistency and accuracy. 4 Although MCQs are not commonly used in assessment of MBBS and medical postgraduate students, these are often the choice for most of the graduate and postgraduate medical entrance examinations. MCQs can be designed to assess the higher cognitive levels of the students. 5 With this prospect, the study was conducted to assess the knowledge and awareness on HIV/AIDS using MCQ as an assessment tool to cover wider area on a topic.

Materials and Methods
The study included 100 1 st MBBS students and 100 2 nd MBBS students under the age group of 18-22 years of KBNIMS, Gulbarga. Institution Ethical Clearance was obtained for the study. Written consent was obtained from the students. The students were given 14 MCQ's on HIV/AIDS. The options given were yes or no type and true or false type. The numbers of options were between 2-4. The results were analysed using frequency and percentage and then compared.

Inclusion criteria
Students under the age group of 18-22 years.

Results
The study showed a better performance of 2 nd year students compared to first year students. The Study shows that 2 nd year students, as compared to 1 st year students, knows the cause of HIV/AIDS (100%). 100% of 2 nd year students answered correctly that it is not curable, whereas, 83% of 1 st year students answered that it is not curable. There was no much difference in answering whether HIV/AIDs is contagious (37% and 30%). Regarding the modes of transmission, 2 nd year students answered 100% for blood transfusion, unsterile needles and sexual transmission, whereas, mother to child transmission, the results were 92%, 73% and 76% respectively for pregnancy, delivery and breastfeeding. 98% of 2 nd MBBS students knows that HIV/AIDS is not spread by mosquito, whereas, 83% in 1 st MBBS students. On prevention of HIV/AIDS, majority of the 2nd MBBS students answered correctly compared to 1 st year students, though not of much difference. Graph 1 shows the prevention of HIV/AIDS, and Graph 2 shows the modes of prevention of HIV/AIDS and Graph 3 shows the modes of transmission of HIV/AIDS.

Discussion
According to Angelo (1995) "Assessment can be defined as an ongoing process aimed at understanding and improving student learning". 6,7 The goal of assessment in medical education is usually to support learning or to establish the competence of individual doctors; it helps person being assessed, identify and respond to his or her own learning needs. 8 MCQs are considered as an efficient and reliable testing tool and could yield valid information of clinical reasoning skills. 6,9 It has also been demonstrated that MCQs have predictive value for more recognized problem solving tasks and can elicit higher order problem solving ability such as forward reasoning. 6,10,11 Magzoub et al concluded that the MCQ test is able to detect learning outcomes in the cognitive domain. 12 MCQs bring a lot of advantages into the assessment process. In the first place, as a result of case specificity; the reliability and content validity of an examination depends on a broad sampling of problems; such sampling is easier to do with tests such as MCQs. 10 In undergraduate medical education, a well-constructed MCQ can easily assess a student's ability to apply, evaluate and judge medical education knowledge. 13,14 Scully (2017) invalidated the perception that MCQs can only assess lower ordered thinking 15 and Palmer EJ and Devitt (2007) illustrated that the percentage of question testing lower ordered thinking is same in both MCQs and MEQs. 16 It also shows that a well-constructed MCQ is a better tool to assess higher ordered thinking in medical students than an MEQ (Palmer & Devitt, 2007). There is nothing innate in the MCQ assessment format which prevents testing of higherordered thinking. 17 Besides, medical schools are training their faculty members to develop multiple-choice questions which ensure assessment of higher ordered thinking of their students. 13 There is a general perception that MCQs emphasize on knowledge recall i.e. Level I of revised Bloom's Taxonomy and MEQs are capable of testing higher ordered thinking. The criticism against MCQs is basically due to      Heterosexual  79  79  21  21  89  89  3  3  9  9  Homosexual  46  46  54  54  89  89  4  4  7  7  Anal intercourse  40  40  60  60  67  67  20  20  13  13  Vaginal intercourse  81  81  19  19  96  96  3  3 1 1

Conclusion
In this study we found that MCQs can be used as assessment tool to compare the knowledge and awareness about HIV/AIDS among UG medical students. We found that the knowledge and awareness of AIDS is better among 2 nd year students who have the topic as core competency to learn.

Acknowledgement
I express my sincere gratitude to all the students who cooperated in the study, and others involved in this study.

Conflict of Interest
None.

Source of Funding
None.