Applying the utility index to review single best answer questions in medical education assessment

In professional training programmes it is vital to ensure individuals have accomplished all required competencies before qualifying, otherwise patient safety could be placed at risk. This increased emphasis on patient safety and accountability has heightened the need for reliable, valid and suitable methods of assessment that not only can inform if learning outcomes have been achieved but can also promote and encourage learning. One method of assessment that has been traditionally applied in clinical education assessment is the Single Best Answer (SBA) question approach. In this review paper, the benefits and limitations associated with using SBA questions as a method of assessment were critically evaluated. The review clearly highlighted that emphasis should be mainly placed upon the design, coverage and content of SBA questions rather than evaluating the concept of SBA questions as a method of assessment. More specifically, the paper pointed towards the complex skills required for developing a set of SBA questions that can both promote learning as well as evaluate learning. To summarise, the need for defining the necessary skills and criteria required for the careful design and successful application of SBA exam paper is an important avenue to investigate.