Functional near-infrared spectroscopy of medical students answering various item types

Syeda Fabeha Husain; Nixi Wang; Roger S McIntyre; Bach X Tran; Thao Phuong Nguyen; Linh Gia Vu; Giang Thu Vu; Roger C Ho; Cyrus S Ho

doi:10.3389/fpsyg.2023.1178753

Functional near-infrared spectroscopy of medical students answering various item types

Front Psychol. 2023 Jun 12:14:1178753. doi: 10.3389/fpsyg.2023.1178753. eCollection 2023.

Authors

Syeda Fabeha Husain^{1

2}, Nixi Wang², Roger S McIntyre^{3

4

5

6}, Bach X Tran^{7

8}, Thao Phuong Nguyen^{9

10}, Linh Gia Vu^{9

9}, Giang Thu Vu^{11

12}, Roger C Ho^{1

13}, Cyrus S Ho¹³

Affiliations

¹ Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore.
² Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
³ Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.
⁴ Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
⁵ Department of Pharmacology, University of Toronto, Toronto, ON, Canada.
⁶ Brain and Cognition Discovery Foundation, Toronto, ON, Canada.
⁷ Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.
⁸ Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
⁹ Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam.
¹⁰ Faculty of Medicine, Duy Tan University, Da Nang, Vietnam.
¹¹ Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam.
¹² Institute of Health Economics and Technology, Hanoi, Vietnam.
¹³ Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.

Abstract

Background: Traditionally, the effect of assessment item types including true/false questions (TFQs), multiple-choice questions (MCQs), short answer questions (SAQs), and case scenario questions (CSQs) is examined through psychometric qualities or student interviews. However, brain activity while answering such questions or items remains unknown. Functional near-infrared spectroscopy (fNIRS) can be used to safely measure cerebral cortex hemodynamic response during various tasks. Hence, this fNIRS study aimed to determine differences in frontotemporal cortex activity as medical students answered TFQs, MCQs, SAQs, and CSQs.

Methods: In total, 24 medical students (13 males and 11 females) were recruited in this study during their mid-psychiatry posting. Oxy-hemoglobin and deoxy-hemoglobin levels in the frontal and temporal regions were measured with a 52-channel fNIRS system. Participants answered 9-18 trials under each of the four types of tasks that were based on their psychiatry curriculum during fNIRS measurements. The area under the oxy-hemoglobin curve (AUC) for each participant and each item type was derived. Repeated measures ANOVA with post-hoc Bonferroni-corrected pairwise comparisons were used to determine differences in oxy-hemoglobin AUC between TFQs, MCQs, SAQs, and CSQs.

Results: Oxy-hemoglobin AUC was highest during the CSQs, followed by SAQs, MCQs, and TFQs in both the frontal and temporal regions. Statistically significant differences between different types of items were observed in oxy-hemoglobin AUC of the frontal region (p ≤ 0.001). Oxy-hemoglobin AUC in the frontal region was significantly higher during the CSQs than TFQ (p = 0.005) and during the SAQ than TFQ (p = 0.025). Although the percentage of correct responses was significantly lower in MCQ than in the other item types, there was no correlation between the percentage of correct response and oxy-hemoglobin AUC in both regions for all four item types (p > 0.05).

Conclusion: CSQs and SAQs elicited greater hemodynamic response than MCQs and TFQs in the prefrontal cortex of medical students. This suggests that more cognitive skills may be required to answer CSQs and SAQs.

Keywords: case scenarios; functional near-infrared spectroscopy; item type; medical examination; multiple choice questions; short answer questions; true/false questions.