Academic journal article American Journal of Pharmaceutical Education

Incorporation of Bloom's Taxonomy into Multiple-Choice Examination Questions for a Pharmacotherapeutics Course

Academic journal article American Journal of Pharmaceutical Education

Incorporation of Bloom's Taxonomy into Multiple-Choice Examination Questions for a Pharmacotherapeutics Course

Article excerpt


Accreditation standards and guidelines for the doctor of pharmacy degree program support the development of critical thinking throughout the curriculum. (1) The American Psychological Association Delphi Report defines critical thinking as "purposeful, self-regulatory judgment which results in interpretation, analysis, evaluation, and inference, as well as explanation of the evidential, conceptual, methodological, criteriological, or contextual considerations upon that which judgment is based." (2)

Several pharmacy educators have measured critical-thinking skills of pharmacy students with standardized instruments such as the California Critical Thinking Skills Test (CCTST) (3-5) and the California Critical Thinking Skills Test Disposition Index (CCTDI). (3,4) Although Philips and colleagues (4) reported improvement in CCTST and CCTDI scores throughout student academic progression in pharmacy school, Cisneros (3) concluded that pharmacy students did not improve their critical-thinking skills during their pharmacy education. However, these measures of critical thinking were designed for students pursuing/ receiving a general college education and are not specific for health science education. The apparent lack of student improvement may be partially attributable to the lack of sensitivity in the CCTST and CCTDI for detecting critical-thinking skills associated with pharmacy education. Another potential weakness of these tests is that they solely measure critical-thinking skills and do not train students to apply their therapeutic knowledge.

An innovative method was needed to test critical-thinking skills specific to students' pharmacotherapeutics knowledge. In addition, this method needed to be linked to examinations and the final course grade in such a manner that it would influence both the materials and the methods by which students study.

Thus, we used Bloom's taxonomy (6) to incorporate critical-thinking skills into multiple-choice examinations with questions designed to span the full range of Bloom's taxonomy categories. Bloom's taxonomy was suggested by Benjamin Bloom who was dedicated to the study of educational objectives and intellectual behaviors important in pedagogy. He proposed a taxonomy of educational objectives to facilitate communication in order to precisely define and classify vaguely defined terms such as "thinking" and "problem solving." Although Bloom's taxonomy identifies 3 domains of learning (cognitive, affective, and psychomotor domain), the cognitive domain is the primary focus of classroom education. As shown in Figure 1, the cognitive domain is hierarchically classified as knowledge, comprehension, application, analysis, synthesis, and evaluation. (6)

Including essay questions in an examination may be an ideal way to evaluate upper hierarchical cognitive levels of Bloom's taxonomy that require critical-thinking skills based on knowledge taught in the classroom. However, such examinations can be time and labor intensive when administered in a large class setting and, therefore, may result in delayed feedback to students. Additionally, when multiple graders are involved, there is the potential for inter-rater variability.

The University of the Pacific School of Pharmacy admits approximately 200 students each year. Because the majority of graduate student assistants at the University of the Pacific do not have complete therapeutics knowledge, they cannot assist faculty members with grading essay examinations of pharmacotherapy courses. Thus, grading such an examination would be a tremendous burden on faculty members attempting to evaluate the upper hierarchical cognition associated with the critical-thinking skills of a class of 200 students.


This article: (1) introduces a methods for incorporating Bloom's taxonomy (6) and concept maps into examination questions in the General Pharmaceutical Care II course (2) shows the quantitative assessment of the correct response fraction and discrimination index of test questions classified by Bloom's taxonomy, and (3) briefly describes students' feedback on the incorporation of Bloom's taxonomy into examinations during the course. …

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