Is it time to embed clinical prioritization questions (CPQs) into the Iranian undergraduate medical education curricula?

Heydari, Meysam; Mohammadi, Aeen

doi:10.61186/edcj.17.56.154

Abstract

Uncertainty is a natural and inevitable part of the medical field (1). In the clinical setting, doctors frequently deal with issues that have several possible interpretations (2). Lately, there has been a focus on the necessity of acknowledging ambiguity and uncertainty in educational programs by medical schools, educators, and students (2). After graduation, medical students must possess the professional competency of being able to accept and manage uncertainty, according to the UK's General Medical Council (GMC) (3). In a similar vein, one of the most crucial skills for physician candidates is the capacity to tolerate uncertainty, according to the Accreditation Council of Graduate Medical Education (ACGME) in the USA (4). As medical students progress in their training, they will encounter numerous clinical uncertainties in all aspects of medical practice (5). Therefore, assessments should authentically address uncertainty to help students prepare for real-world clinical challenges (6). But there is a question that deserves attention: Are the current assessment tools appropriate enough to support uncertainty tolerance among medical students, particularly the written assessment tools? In undergraduate medical education, medical schools still widely use multiple-choice questions (MCQs) with a best-answer approach (A-type MCQs) (7). Despite their popularity, this examination format may inadvertently suggest to students that there is always a single correct answer, which may not align with real clinical experiences (7). Sam et al. recently created the Clinical Prioritization Questions (CPQs), an innovative assessment instrument (8). Students must rank potential diagnoses in CPQs from most likely to least likely, based on likelihood (8). The outcomes show how well this Question format works to support students' growth in clinical reasoning abilities. CPQs also significantly contribute to cultivating students' competence in managing clinical uncertainty (8). One of the existing challenges that educators face is the different marking system of CPQs, which, unlike A-type MCQs, learners can get a range of marks. Therefore, faculty development in terms of the nature and marking system of CPQs can play an important role in dealing with this challenge. Also, students' lack of familiarity with the CPQs is another challenge. So, it is suggested that before using CPQs, educational sessions should be held with the students concerning the format of CPQs. Given the significance of managing uncertainty and ambiguity in their future medical careers, it is imperative to incorporate specific strategies into the curriculum to equip medical students to deal with clinical uncertainty. It is recommended that CPQs be used as a valuable formative assessment tool, due to their capability to meet this demand. Iranian medical schools may find implementing CPQs more practical and useful than other clinical reasoning assessment tools. However, before any embedment in the curriculum, pilot studies for revealing utility aspects of CPQs (e.g., validity, reliability, educational impact, acceptability, and feasibility) in Iranian settings are needed.

Is it time to embed clinical prioritization questions (CPQs) into the Iranian undergraduate medical education curricula?

Author: Heydari, Meysam; Mohammadi, Aeen

Publisher: Zenodo

DOI: 10.61186/edcj.17.56.154

Source: https://zenodo.org/records/17255408/files/article-1-2229-en.pdf

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Is i ime o embed clinical p io i iza ion ques ions (CPQs) in o he
I anian unde g adua e medical educa ion cu icula?
Meysam Heyda i 1* , Aeen Mohammadi 2
1PhD S uden in Medical Educa ion a he School o Medicine, Teh an Uni e si y o Medical Sciences, Teh an, I an.
2 MD, MPH, PhD. Associa e P o esso , Depa men o E-Lea ning in Medical Educa ion, School o Medicine, Cen e o Excellence o E-Lea ning in Medical
Educa ion, Teh an Uni e si y o Medical Sciences, Teh an, I an.
A icle in o
Unce ain y is a na u al and ine i able pa o he
medical ield (1). In he clinical se ing, doc o s
equen ly deal wi h issues ha ha e se e al possible
in e p e a ions (2). La ely, he e has been a ocus on
he necessi y o acknowledging ambigui y and
unce ain y in educa ional p og ams by medical
schools, educa o s, and s uden s (2).
A e g adua ion, medical s uden s mus possess he
p o essional compe ency o being able o accep and
manage unce ain y, acco ding o he UK's Gene al
Medical Council (GMC) (3). In a simila ein, one o
he mos c ucial skills o physician candida es is he
capaci y o ole a e unce ain y, acco ding o he
Acc edi a ion Council o G adua e Medical
Educa ion (ACGME) in he USA (4).
As medical s uden s p og ess in hei aining, hey
will encoun e nume ous clinical unce ain ies in all
aspec s o medical p ac ice (5). The e o e,
assessmen s should au hen ically add ess
unce ain y o help s uden s p epa e o eal-wo ld
clinical challenges (6).
Bu he e is a ques ion ha dese es a en ion: A e
he cu en assessmen ools app op ia e enough o
suppo unce ain y ole ance among medical
s uden s, pa icula ly he w i en assessmen ools?
In unde g adua e medical educa ion, medical
schools s ill widely use mul iple-choice ques ions
(MCQs) wi h a bes -answe app oach (A- ype
MCQs) (7). Despi e hei popula i y, his
examina ion o ma may inad e en ly sugges o
s uden s ha he e is always a single co ec answe ,
which may no align wi h eal clinical expe iences
(7).
Sam e al. ecen ly c ea ed he Clinical P io i iza ion
Ques ions (CPQs), an inno a i e assessmen
ins umen (8). S uden s mus ank po en ial
diagnoses in CPQs om mos likely o leas likely,
based on likelihood (8). The ou comes show how
well his Ques ion o ma wo ks o suppo s uden s'
g ow h in clinical easoning abili ies. CPQs also
signi ican ly con ibu e o cul i a ing s uden s'
compe ence in managing clinical unce ain y (8).
One o he exis ing challenges ha educa o s ace is
he di e en ma king sys em o CPQs, which, unlike
A- ype MCQs, lea ne s can ge a ange o ma ks.
The e o e, acul y de elopmen in e ms o he
na u e and ma king sys em o CPQs can play an
impo an ole in dealing wi h his challenge. Also,
s uden s' lack o amilia i y wi h he CPQs is ano he
challenge. So, i is sugges ed ha be o e using
CPQs, educa ional sessions should be held wi h he
s uden s conce ning he o ma o CPQs.
Gi en he signi icance o managing unce ain y and
ambigui y in hei u u e medical ca ee s, i is
impe a i e o inco po a e speci ic s a egies in o he
cu iculum o equip medical s uden s o deal wi h
clinical unce ain y. I is ecommended ha CPQs be
used as a aluable o ma i e assessmen ool, due o
How o ci e his a icle:
Heyda i M, Mohammadi A. Is i ime o
embed clinical p io i iza ion ques ions
(CPQs) in o he I anian unde g adua e
medical educa ion cu icula? J Med
Educ De . 2024; 17(56): 154-155.
Heyda i e al . J Med Edu De . 2024; 17(56): 154-155 Jou nal o Medical Educa ion De elopmen
Le e o he edi o
A icle his o y:
Recei ed 23 Jul. 2024
Accep ed 10 Aug. 2024
Published 14 Dec. 2024
*Co esponding au ho :
Meysam Heyda i, PhD S uden o Medical Educa ion,
School o Medicine, Teh an Uni e si y o Medical
Sciences, Teh an, I an.
Email: Meysam10heida [email protected]
[ DOI: 10.61186/edcj.17.56.154 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ]
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Heyda i e al.: Is i ime o embed clinical p io i iza ion ques ions (CPQs) in o he I anian unde g adua e medical educa ion
cu icula?
Jou nal o Medical Educa ion De elopmen ¦ Volume 17 ¦ Issue 56¦ 2024 155
hei capabili y o mee his demand. I anian medical
schools may ind implemen ing CPQs mo e
p ac ical and use ul han o he clinical easoning
assessmen ools. Howe e , be o e any embedmen
in he cu iculum, pilo s udies o e ealing u ili y
aspec s o CPQs (e.g., alidi y, eliabili y,
educa ional impac , accep abili y, and easibili y) in
I anian se ings a e needed.
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