A case of confusion: context matters when using reference images on exams
Authors: Downey Ryan 
Published: May 2024

Instructors utilize reference figures from textbooks, journals, and other sources on quizzes and exams to illustrate concepts that would otherwise be diffcult to convey using written text. Examples within biomedical teaching include anatomical images and graphs that students are expected to analyze or interpret. However, the use of a figure may cause confusion and lead students to select an incorrect answer. As such, instructors must evaluate the use of figures to ensure that they enhance students’ ability to correctly answer the question rather than hinder it. This report shows an example where the inclusion of a reference figure led to the majority of students incorrectly answering a question.Over 6 semesters in a master’s level graduate neuroscience course between 2019 and 2021, the same question was used with and without a reference figure in a variety of contexts to determine the factors that contributed to students overwhelmingly selecting an incorrect answer. In the question, students were asked to identify neuroarchitectural adaptations in the somatosensory cortex following amputation. To determine the correct answer, students needed to integrate knowledge of the discriminative touch sensory pathways with knowledge of cortical plasticity.In semesters where the figure was presented without specific teaching interventions, 57% of students selected an incorrect answer that utilized the proximity of cortical sites but was not supported by the signaling pathways. In these semesters, only 39% of students correctly answered. In semesters where the figure was not used, 94% of students correctly answered the question while only 6% of students selected the most common incorrect answer when the figure was present.Teaching interventions were introduced during two semesters in an attempt to “teach the question.” Students were asked to read primary literature on the topic, additional examples and cases were introduced, and in one semester, a similar practice question using was given to the students. Students were then presented with the question containing the image. 56% of students selected the most common incorrect answer while only 42% of students correctly answered the question.While no formal survey of the students was conducted, anecdotal evidence from student offce hours, directed inquiries, and casual conversations indicate that students generally felt that use of the figure, when present, was critical to answering the question and many reported that using the figure led them to prioritize their knowledge of cortical plastic adaptations over that of the signaling pathways.These results demonstrate the importance of carefully utilizing reference images on questions for quizzes and exams. The visual cues of the image can be powerful stimuli for students when analyzing the information and can sometimes lead to incorrect answers on the assessment. This work was supported by internal funding from the Georgetown University Graduate School of Biomedical Sciences and Georgetown University Medical Center’s Center for Innovation and Leadership in Education (CENTILE). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.