Council on Medical Student Education in Pediatrics


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COMSEP Meeting in Ottawa, ON

Poster Presentation:

A card is worth a thousand questions: Leveraging the power of key features and semantic qualifiers in writing clinical questions

Susan L. Bannister,University of Calgary,Calgary,AB,Hosanna . Au,University of Toronto,Toronto,ON,Karen L. Forbes,University of Alberta,Edmonton,AB,Marc . Zucker,University of Ottawa,Ottawa,ON,Gabriele . Weiler,University of Ottawa,Ottawa,ON,MIchael K. Paget,University of Calgary,Calgary,AB




E-learning specialists at the University of Calgary developed an educational technology called "Cards”, collections of short clinical vignettes with associated questions.  The cards make use of key features and semantic qualifiers that help students compare and contrast different diagnostic considerations.  Literature suggests that using these elements in the problem representation of a clinical case is associated with strong clinical reasoning.





To build a collection of clinical vignettes and associated questions, using the innovative “card”  technology, that are aligned with canuc-paeds (Canadian undergraduate curriculum in paediatrics) for use as a formative learning resource for students.





Using the technology developed at the University of Calgary, PUPDOC (Paediatric Undergraduate Program Directors of Canada) members wrote card templates that could be used to generate thousands of unique vignettes, with associated questions.  Starting with a clinical presentation, a short case was written.  Case authors determined which factors in the case were key features and which were not.   The key features of each case were anchored to appear in every clinical card.  The elements of the case that could be variable and do not change clinical reasoning were set to be randomized when cards are generated.    


Each card asks a clinical question, and after students select their answer, the correct answer is immediately displayed, along with an explanation and links to further learning resources.

Following the process of card development, cards were peer-reviewed by PUPDOC members for content and clarity using a standardized rubric.   Cards will be available as an open-access resource.




Over the course of one curricular development day, 63 card templates were written that covered 9 clinical presentations.   Each card template can generate thousands of clinical vignettes and clinical questions.  





Given that thousands of questions can be generated based on several hours of work using the Cards technology, a short investment by faculty is transformed into huge learning potential for students.  Variation in vignettes allows students to encounter a large range of unique scenarios to assist them in recognizing key features, making cards an effective resource to promote diagnostic reasoning skills.


The open-access questions allow students to either create an account or just “jump right in” and start playing.   The technology will track individual students’ accuracy of answers, progress, and development of proficiency.   The software will generate both immediate feedback as well as longitudinal feedback on any given clinical presentation.  Every time students draw a new card, cards they have answered incorrectly or haven’t played for an extended period are favored in the selection process.