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Summary
- I mention the effectiveness of practice quizzes as a learning tool, as evidenced by numerous studies.
- I discuss John Dunlosky’s article on the benefits of practice quizzes over re-reading for content review.
- I note the infrequent usage of practice quizzes in college courses, attributing it to the time-consuming nature of creating them.
- I introduce the use of ChatGPT-4 Plus as a tool for generating draft quizzes, speeding up the creation process.
- I convey my conviction that there’s little reason not to provide students with practice quizzes, given this streamlined process.
- I share a unique group activity approach to review quizzes, inspired by Professor Mary Anne Fitzpatrick.
- I narrate my personal experience of opting for an exam in professor Fitzpatrick’s class, introducing me to a new exam review study strategy.
- I describe the “detective work” study method, where students generate quiz questions for given quiz answers, which I’ve used in my own teaching.
- I detail my process of using ChatGPT to generate multiple-choice quizzes, that include explanations and key terms for each question.
- I give examples of using this process for the topics of “electrolytes” and the “coagulation cascade,” including the prompts I used.
We have known for over a 100 years that practice quizzes are one of the most effective ways for students to review course content. Numerous high-quality studies have confirmed this: time and again, they demonstrate that practice quizzes are among the top strategies for learning.
John Dunlosky explains this concept in his article titled “Strengthening the Student Toolbox: Study Strategies to Boost Learning” (which is a short, busy reader-friendly version of a serious peer-reviewed version published earlier). He explains that students often re-read the assigned material, which is the most widespread, popular study method, which – alas – has been proven to be one of the least effective ways of reviewing course content. Dunlosky lists several benefits of using practice quizzes instead of re-reading: The first is that during practice quizzes, students must retrieve necessary information from memory, and this act of retrieval makes the knowledge last longer. Another benefit is that practice quizzes pinpoint the areas in the material where students’ knowledge is lacking, effectively pointing out which parts of the study material need additional attention and review.
Despite these benefits and over 100 years of solid, scholarly evidence providing strong support for their effectiveness, the use of practice quizzes is still surprisingly rare in college courses. One of the main reasons for this might be that writing good quizzes has always been time-consuming.
Not any more: ChatGPT comes to the rescue! I have tested ChatGPT-4 Plus (May 23 version) as a tool for generating quizzes on specific academic topics. It can now easily generate a 15-question draft quiz. It can also provide reasonably good explanations for correct and incorrect answers. I have included below the prompts I used and samples of what was generated using this method. The generated quizzes may not be quite perfect yet, but they get you 85% of the way there, and take significantly less time to edit and correct than writing them from scratch. With this kind of head start, there is little excuse not to provide students with this effective, evidence-backed type of practice. This is especially true for major assessments that impact the course grade, like midterms and finals.
Practice quizzes can be made available to students for individual study, but they also lend themselves easily to being used as a group activity. Here is a review strategy I learned back in grad school, from professor Mary Anne Fitzpatrick.
Long ago, I took a nonverbal communication course with professor Fitzpatrick. The class was a mix of undergraduate and graduate students. As a doctoral student doing a minor in communications, I had a choice: at the end of the first lecture, professor Fitzpatrick offered all graduate students a choice of writing a paper or taking three exams with the undergrads. I was working on several long papers that semester, and the idea of having the option to take a multiple-choice exam instead seemed refreshing. I opted for taking the exam. Professor Fitzpatrick was surprised – not many grad students did that, and she warned me that poor exam performance couldn’t be remedied by other coursework later. Despite this, I decided to take the risk. When the first midterm approached, professor Fitzpatrick gave us materials to review: it was unlike anything I had seen before! She gave us the complete text of the exam, which had multiple-choice questions with potential answers, but the question itself was not included. We were supposed to review the potential answers, and come up with the best question for each set. This strategy was challenging yet surprisingly fun because it felt like detective work: we had four answers and a missing question! We had to come up with a plausible question, and then, we had to decide which of those answers would be the best (that is, correct) answer for the question we just came up with.
I did well in that course, and got an A. However, the best takeaway was this unique study strategy. I have since employed it in my own courses I taught as a college professor: it is one of the most clever and yet rarely used strategies to help students study for exams. Because of the detective nature of this approach, these questions work well for both individual review and group work, and they can be used as optional homework assignments or for in-class activities in active learning classrooms.
I have included the prompts for this multi-step process below. I usually start by generating a simple list of 10 to 15 open-ended questions on a fairly specific topic. This lets me quickly review the questions to ensure everything looks correct. The second prompt asks ChatGPT to reformat these questions into a multiple-choice quiz, with correct answers marked with an asterisk at the end of the sentence. To ensure randomness, I had to tweak the prompt: the earlier versions made answer ‘A’ consistently correct, making the quiz 100% predictable.
Once the quiz is generated, I ask for a follow-up: this includes all the questions with a brief explanation of why the correct answer is correct and why the other potential distractors were incorrect. I also asked ChatGPT to suggest key terms that students should review for each question. In the undergraduate program I work with, students have access to a very good, electronic resource that works on both their computers and phones and includes Taber’s Medical Terms Dictionary, and several other similar (reliable and frequently updated) resources.
Below are examples for three different topics. First, I included the prompts I used. Then, for the first topic, patient safety, I included the full generated quiz, and in-class activity sample for Q 1-5. This is a good example to evaluate to what degree the quiz is correct and what edits have to be made to make it useable. Next, for the coagulation cascade, (which is always a challenging topic for first-year nursing program undergraduates), I included just a few example questions, as they could be used in the active learning classroom setting. .This approach encourages active learning, and engages students in a unique way. Now that we have a tool to streamline the creation of quizzes, I hope that more educators will re-consider using practice quizzes in their courses!
Appendix – Exemplars
Prompts:
- P1: Assume you are a college instructor teaching an undergraduate college course on physiology. Create a 15 question practice quiz on the topic of: electrolytes. Provide answer key.
- P3: Rewrite this quiz in a multiple-choice format, with correct answers marked by an asterisk “*” placed at the end of the answer. Alternate randomly which answer (A, B, C, or D) is correct for each question.
- P3: Rewrite the multiple-choice quiz you generated above. Provide a brief, one or two paragraph explanation for the correct choice in each question, and explain why the other choices were incorrect. Do not use letters for correct answers, instead quote the complete answer in quotes. Also include: the original quiz question, the explanation, and a list of key terms students should review for that question.
Student Activity Instructions: Below is an incomplete draft of a quiz intended to help students review “TOPIC.” Presently there are only the 4 answers for each question (one is correct). Working INDIVIDUALLY / IN GROUPS, come up with (= generate) the best possible question for these answers, and select the answer that would be correct (keep the TOPIC of this quiz in mind!).
Sample: Patient safety
Sure, here’s a practice quiz focused on patient safety:
Prompt 1 > Open-Ended Questions: Patient Safety
- Define the term “patient safety” in the context of healthcare.
- List three common types of preventable medical errors.
- What is the “Swiss cheese model” in healthcare and how does it relate to patient safety?
- Briefly describe the role of a patient safety officer.
- What are the main elements of creating a safety culture in a healthcare facility?
- Describe the concept of “Do No Harm” and how it applies to patient safety.
- Explain the significance of “hand hygiene” in patient safety.
- How does communication play a crucial role in ensuring patient safety?
- Explain the use and importance of bar-coded medication administration (BCMA) in patient safety.
- How can healthcare providers reduce the risk of patient falls?
- What are “Never Events”? Provide an example.
- Explain the role of incident reporting in maintaining and improving patient safety.
- How does the concept of “patient-centered care” contribute to patient safety?
- What is a “root cause analysis” and how is it used in the context of patient safety?
- Describe the impact of health information technology on patient safety.
Answer Key:
- Patient safety refers to the prevention of harm to patients during the process of health care. It includes strategies and practices to mitigate the risk of avoidable patient harm.
- Common preventable medical errors include medication errors, surgical errors, and diagnostic errors.
- The Swiss cheese model in healthcare describes a system where, despite multiple layers of defense (slices of Swiss cheese), hazards can still cause harm if they pass through the holes (weaknesses) in each layer. It’s a concept used to explain how accidents occur and how to prevent them.
- A patient safety officer ensures that all care provided within a healthcare facility is safe. They oversee safety protocols, analyze incidents, provide training, and work to continuously improve safety standards.
- The main elements of creating a safety culture include leadership commitment to safety, non-punitive response to errors, learning from errors, and teamwork.
- “Do No Harm” is a core principle of healthcare, emphasizing that patient safety should be a priority and that healthcare providers should avoid causing pain, suffering, or injury to patients.
- Hand hygiene is one of the most effective ways to prevent the spread of infections, thus playing a crucial role in patient safety.
- Clear, accurate, and timely communication among healthcare providers can prevent misunderstandings, reduce errors, and improve patient safety.
- BCMA ensures correct medication administration by verifying that the right patient receives the right medication in the right dose at the right time via the right route, thereby significantly reducing medication errors.
- Healthcare providers can reduce the risk of patient falls by assessing fall risk, implementing individualized fall prevention plans, ensuring proper lighting and assistive devices, and educating patients and families about fall risks.
- “Never Events” are serious incidents that are wholly preventable because guidance or safety recommendations that provide strong systemic protective barriers are available at a national level. An example is surgery performed on the wrong body part.
- Incident reporting allows healthcare organizations to identify and analyze incidents that could lead, or have led, to unintended and/or unnecessary harm to patients. It’s a key part of safety improvement, enabling learning and prevention of recurrence.
- Patient-centered care emphasizes respect for and responsiveness to individual patient preferences, needs, and values. It helps improve patient safety by ensuring that care is tailored to the individual, reducing the risk of unnecessary treatments or mistakes.
- Root cause analysis is a method of problem-solving used to identify the root causes of faults or problems. In patient safety, it’s used after an adverse event to identify why the event occurred and to determine what can be done to prevent it from happening again.
- Health information technology, such as electronic health records and computerized physician order entry, can enhance patient safety by improving accuracy, enhancing communication, reducing medication errors, and providing clinical decision support.
Prompt 2: The same quiz rewritten in a multiple-choice format:
- What does the term “patient safety” refer to in healthcare?
A. The cost of patient care.
B. The speed of service delivery.
C. The prevention of harm to patients during health care.*
D. The patient’s satisfaction with the service. - Which of the following are common types of preventable medical errors?
A. Medication errors, surgical errors, and diagnostic errors.*
B. Medication errors, long waiting times, and administrative errors.
C. Communication errors, diagnostic errors, and therapeutic errors.
D. Surgical errors, long waiting times, and poor bedside manners. - What is the “Swiss cheese model” in healthcare?
A. A model for efficient hospital management.
B. A system where hazards can still cause harm if they pass through weaknesses in each layer of defense.*
C. A model for nutritional advice.
D. A system of classification for different types of medical errors. - What is the role of a patient safety officer?
A. To oversee the hospital’s financial matters.
B. To coordinate patient transport within the hospital.
C. To ensure that all care provided within a healthcare facility is safe.*
D. To assist patients with personal care tasks. - Which of the following is not a main element of creating a safety culture in a healthcare facility?
A. Leadership commitment to safety.
B. Non-punitive response to errors.
C. High staff turnover rates.*
D. Learning from errors. - What does the concept of “Do No Harm” mean?
A. Only use non-invasive procedures.
B. Healthcare providers should avoid causing pain, suffering, or injury to patients.*
C. Don’t ask patients about their medical history.
D. Always give patients the most expensive treatment. - Why is hand hygiene crucial in patient safety?
A. It helps to build strong muscles in the hand.
B. It is a requirement for accreditation.
C. It is one of the most effective ways to prevent the spread of infections.*
D. It reduces the cost of care. - How does communication affect patient safety?
A. Communication has no impact on patient safety.
B. Better communication leads to higher profits for the healthcare facility.
C. Clear, accurate, and timely communication can prevent misunderstandings and reduce errors.*
D. Communication only affects patient satisfaction, not safety. - What is the purpose of bar-coded medication administration (BCMA) in patient safety?
A. To reduce the cost of medication.
B. To ensure the correct medication administration, thereby reducing medication errors.*
C. To make it easier for the pharmacist to manage stock.
D. To ensure patients can self-administer their medications. - How can healthcare providers reduce the risk of patient falls?
A. By charging patients for any damage they cause when they fall.
B. By ensuring proper lighting and assistive devices, among others.*
C. By restraining patients who are at risk of falling.
D. By encouraging patients to walk as much as possible. - What are “Never Events”?
A. Events that are unlikely to happen in a healthcare setting.
B. Events that are not covered by insurance.
C. Serious incidents that are wholly preventable because safety recommendations are available at a national level.*
D. Mistakes made by new staff members. - Why is incident reporting important for patient safety?
A. It provides an opportunity to blame staff for mistakes.
B. It allows healthcare organizations to identify and analyze incidents that could lead to patient harm.*
C. It creates more paperwork for administrators.
D. It is a legal requirement, but it does not affect patient safety. - How does “patient-centered care” contribute to patient safety?
A. It increases the cost of care.
B. It makes patients feel more comfortable.
C. It helps improve patient safety by ensuring care is tailored to the individual.*
D. It is not related to patient safety. - What is a “root cause analysis”?
A. A type of medical test.
B. A method of problem-solving used to identify the root causes of faults or problems.*
C. A way of assigning blame for an incident.
D. A management technique for improving staff morale. - How does health information technology impact patient safety?
A. It makes care more expensive.
B. It creates more work for healthcare providers.
C. It can enhance patient safety by improving accuracy, enhancing communication, and reducing medication errors.*
D. It has no impact on patient safety.
The quiz above could be used for an active-learning activity – here is the example for Q1 with answer key, and answer key for the remaining questions:
Q1 What would be the best question to match the following answers?
A. The cost of patient care.
B. The speed of service delivery.
C. The prevention of harm to patients during health care.
D. The patient’s satisfaction with the service.
Question: What does the term “patient safety” refer to in healthcare?
Correct Answer: “The prevention of harm to patients during health care.”
Explanation: Patient safety refers to the practices and measures used to prevent harm to patients during health care. It’s about avoiding errors, accidents, and infections that can occur in the process of medical treatment. Other options are either unrelated to patient safety or are outcomes of good patient safety but not the definition itself.
Key Terms: Patient Safety
Answer key for Q2-5
Quiz: Patient Safety
- Question: Which of the following are common types of preventable medical errors? Correct Answer: “Medication errors, surgical errors, and diagnostic errors.” Explanation: These are all mistakes that can occur in a healthcare setting and can often be prevented through proper protocols and procedures. The other options can also be errors but are not as commonly classified as preventable medical errors. Key Terms: Preventable Medical Errors, Medication Errors, Surgical Errors, Diagnostic Errors.
- Question: What is the “Swiss cheese model” in healthcare? Correct Answer: “A system where hazards can still cause harm if they pass through weaknesses in each layer of defense.” Explanation: The Swiss cheese model in healthcare demonstrates that even with multiple safeguards (cheese slices), errors (holes in the cheese) can align to allow a hazard to reach the patient. Other options are either unrelated to this model or incorrect descriptions of it. Key Terms: Swiss Cheese Model, Defense Layers, System Weaknesses.
- Question: What is the role of a patient safety officer? Correct Answer: “To ensure that all care provided within a healthcare facility is safe.” Explanation: A patient safety officer oversees safety protocols, analyzes incidents, and works to continuously improve safety standards in a healthcare facility. The other choices relate to different roles within a healthcare organization. Key Terms: Patient Safety Officer, Safety Protocols, Incident Analysis.
- Question: Which of the following is not a main element of creating a safety culture in a healthcare facility? Correct Answer: “High staff turnover rates.” Explanation: High staff turnover rates can actually undermine a safety culture by disrupting continuity and losing institutional knowledge. The other options are key elements of a safety culture. Key Terms: Safety Culture, Staff Turnover.
Sample: The coagulation cascade
- What would be the best question to match the following answers?
A. To aid in digestion
B. To provide energy
C. To regulate body temperature
D. To form a clot to stop bleeding after a blood vessel has been injured
Question 1: What is the primary purpose of the coagulation cascade in the human body? The correct answer is “To form a clot to stop bleeding after a blood vessel has been injured.” The coagulation cascade is a complex process that the body uses to form clots and prevent excessive bleeding whenever a blood vessel is injured. The options “To aid in digestion,” “To provide energy,” and “To regulate body temperature” are incorrect as they are not functions related to the coagulation cascade.
Key Terms: Coagulation Cascade, Clot Formation, Fibrin Clot. - What would be the best question to match the following answers?
A. The extrinsic pathway, the intrinsic pathway, and the common pathway *
B. The passive pathway, the active pathway, and the common pathway
C. The internal pathway, the external pathway, and the uncommon pathway
D. The common pathway, the unique pathway, and the intrinsic pathway
Question 2: What are the three main pathways of the coagulation cascade? The correct answer is “The extrinsic pathway, the intrinsic pathway, and the common pathway.” Each pathway involves different factors and triggers but eventually converges at the common pathway, leading to clot formation. The options “The passive pathway, the active pathway, and the common pathway,” “The internal pathway, the external pathway, and the uncommon pathway,” and “The common pathway, the unique pathway, and the intrinsic pathway” are incorrect as they are not recognized pathways in the coagulation cascade.
Key Terms: Extrinsic Pathway, Intrinsic Pathway, Common Pathway.
Credits: Image by Ferhat Deniz Fors, licensed via Unsplash+ / GenTag 2307070600-GJ
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