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Indian Journal for the Practising Doctor

Extended Response Essay Questions – A Relook

Author(s): Barkur R, Bhat PP, Kamath U

Vol. 4, No. 6 (2008-01 - 2008-02)

Barkur R, Bhat PP, Kamath U

ISSN: 0973-516X

Rajashekar Barkur and Ullas Kamath are from the Department of Biochemistry, Melaka Manipal Medical College (Manipal Campus), International Centre for Health Sciences, Manipal, Karnataka, India

Parineetha P Bhat is from the Department of Biochemistry, Belgaum Institute of Medical Sciences, Belgaum- Karnataka.

Correspondence: Mr. Rajashekar Barkur, Department of Biochemistry, Melaka Manipal Medical College (Manipal Campus), International Centre for Health Sciences, Manipal-576104 Karnataka, India
E- Mail: rajashekarraob (at)


Extended response essay questions (EREQ) have a lot of potential and can be used to assess higher order skills in students, including problem solving, decision making and written communication skills. This study compares the performance of two cohorts of students undertaking EREQ or restricted response questions (RRQ). Students belonging to the ‘successful’ category fared well in both type of questions. However, the weaker students did significantly better in the RRQ when compared to EREQ. This suggests that EREQ have a valuable role in assessing the higher order skills of students.

Keywords: EREQ, RRQ, assessment, problem solving, written communication


The need to develop higher order thinking skills in students is an important element of under graduate medical education. Periodic assessments seem to be the most important spur that drives student learning1. When teachers opt to assess higher order thinking they must provide students with an opportunity to respond in an extendedresponse format, one that requires analysis, synthesis, and evaluation2. However use of EREQ, based on an authoritarian model of assessment, is seen as inherently flawed in its apparent lack of objectivity. But the question arises whether we can do away altogether with the use of EREQ as a method for determination of complex learning outcomes which cannot be measured by other means like the restricted response essay questions (RRQ)?. Previous studies indicate that a restrictedresponse essay decisively limits the form and content of students’ responses3.

Why use EREQ?

Bloom’s ‘taxonomy’ of intellectual skills is widely used to explain how skills are developed within higher education4. He identifies a hierarchy of progressively more demanding thinking skills, each of which necessitates first acquiring the ‘lower’ skills. In this hierarchy, the lower order skills include i) remembering information, ii) comprehension, and iii) application of knowledge. These three ‘lower order’ intellectual skills form the basis for development of the ‘higher order’ skills of analysis, synthesis and evaluation4. What distinguishes higher education from, for example, further education is the emphasis placed on the development of these thinking skills. The role of assessment, over the period of students’ studies, is to progressively facilitate this developmental process. We consider EREQ to be a valuable vehicle for this development. Essay-writing offers students an opportunity to consolidate and extend their learning. This they put ‘on display’ by communicating what they have learnt within the framework of a formal, ordered statement5. Essays are good for assessing a wide range of skills including planning, selecting, organizing and presenting. Furthermore, the EREQ may be a useful paper and pencil tool in evaluating clinical reasoning.

Table 1: Students’ feedback on EREQ

S. No Response Average
1. Helps to integrate my knowledge in biochemistry 3.52
2. Makes me more responsible in studies 3.23
3. Increases my written presentation skills 3.00
4. Increases my problem solving abilities 3.27
5. Increases my understanding of Biochemistry 3.21

٭ Shown are ratings of the items in a questionnaire provided to students (n=105 students) Ratings were evaluated using a 5-point Likert scale (where 5 is strongly agree and 1 is strongly disagree).


The study was undertaken among the first year undergraduate medical students of Melaka Manipal Medical College (Manipal Campus) India. Biochemistry is studied in the first year along with anatomy and physiology. The curriculum is integrated horizontally and studied over a period of one year in four blocks. At the end of each block, the students were evaluated by both theory and practical examinations. The theory examination usually consisted of restricted response type of questions (RRQ) of 60 marks and multiple true/false questions (Multiple Response Questions). One EREQ, which accounted for 25% of total marks, was introduced for the first time as a part of the 2nd block examination for a class of 121 students. The remaining marks were derived from seven RRQs. The EREQ was framed such that the students should relate knowledge from several learning objectives, correlate, draw conclusions and present in an organized manner. (The question was on the ‘metabolic adaptations occurring in the adipose tissue and liver during starvation’ which required the students to correlate between lipid and carbohydrate metabolisms). The marking of the EREQ was done by a single faculty member following a marking plan which was prepared by inputs from the faculty members, taking into consideration the knowledge that was expected from the students. This was done mainly to ensure objectivity in the marking system. The marking of RRQ was also done by a single faculty member for a particular question following an answer key.


Students were categorized into two groups, based on their total marks: the first group was the failures (F) group consisting of students who were unable to meet the required pass marks of 50% The second group consisted of students who had passed (P group) and scored more than 50%. We compared the % mean scores in the EREQ and RRQ in both these groups. A student-t test was applied to know the significance of the association. Students in the P group (n=69) had scored nearly equally in both EREQ and RRQ (Figure 1). The students of the F group (n=52) had scored significantly more (p<0.001) in the RRQ than in the EREQ (Figure-1). Students’ feedback was also taken (Table 1). The students were asked to rate the assessment methodology on a 5-point Likert scale in which 5 is ‘strongly agree’ and 1 is ‘strongly disagree’.

Figure 1

Comparison of Mean Marks


In our study, we have found that students of the P group scored nearly equal marks in the EREQ and RRQ, indicating that these students were better equipped with information processing skills, decision making skills, ability to correlate topics, and the necessary written communication skills. However, the students in the F group did significantly better in the RRQ. The reasons may be numerous, including the fact that the RRQs are more objective and do not require the actual assimilation of concepts. This suggests that, in the quest for objectivity, which is the current trend of assessments, we may be losing focus on the main reason for having assessments in the first place. Students’ feed back suggests that they also feel that EREQ-based assessment helps them to integrate and increase the understanding of the subjects (Table 1).

EREQ assess the written communication skills which are considered as essential as the acquisition of knowledge. To achieve competence in answering EREQ necessitates the development of organization (or self management) skills, which includes the requirement to meet the deadline of finishing the assignment in the allotted time frame. Inclusion of EREQ in examinations will encourage the students to develop these skills. EREQ still have a role in undergraduate medical assessments, therefore, and efforts should be made to incorporate EREQ into assessments along with other restricted response/objective type of questions.


  1. Ben-David FM: Association of Medical Education in Europe guide no. 14: outcome-based education: part 3-assessment in outcome-based education. Medical Teacher, 1999. 21: 23–25.
  2. Criswell JR, Criswell SJ: Asking essay questions: answering contemporary needs. Education,2004; Vol 124, Spring. [ 00404/ai_n9345192]
  3. Popham WJ: Classroom assessment : What teachers need to know. 3rd ed, 2002. Boston: Allyn & Bacon.
  4. Bloom B. 1965 : Cognitive domain. In: Handbook 1: Taxonomy of Educational Objectives. New York, USA, Mckay .
  5. Hounsell D and Murray R: Essay Writing for Active Learning (Effective Learning and Teaching in Higher Education, Module 9.) Sheffield: CVCP Universities’ Staff Development and Training Unit, 1992.
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