The Effect of English Language on Multiple Choice
Question Scores of Thai Medical Students
Pochamana Phisalprapa MD*, Wayuda Muangkaew BSc*,
Jintana Assanasen MD*, Tada Kunavisarut MD*, Torpong Thongngarm MD*,
Theera Ruchutrakool MD*, Surapon Kobwanthanakun MD*, Wanchai Dejsomritrutai MD*
Affiliation :
* Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Universities in Thailand are preparing for Thailand’s integration into the ASEAN Economic Community
(AEC) by increasing the number of tests in English language. English language is not the native language of Thailand.
Differences in English language proficiency may affect scores among test-takers, even when subject knowledge among
test-takers is comparable and may falsely represent the knowledge level of the test-taker.
Objective : To study the impact of English language multiple choice test questions on test scores of medical students.
Material and Method: The final examination of fourth-year medical students completing internal medicine rotation contains
120 multiple choice questions (MCQ). The languages used on the test are Thai and English at a ratio of 3:1. Individual
scores of tests taken in both languages were collected and the effect of English language on MCQ was analyzed. Individual
MCQ scores were then compared with individual student English language proficiency and student grade point average
(GPA).
Results : Two hundred ninety five fourth-year medical students were enrolled. The mean percentage of MCQ scores in Thai
and English were significantly different (65.0±8.4 and 56.5±12.4, respectively, p<0.001). The correlation between MCQ
scores in Thai and English was fair (Spearman’s correlation coefficient = 0.41, p<0.001). Of 295 students, only 73 (24.7%)
students scored higher when being tested in English than in Thai language. Students were classified into six grade categories
(A, B+, B, C+, C, and D+), which cumulatively measured total internal medicine rotation performance score plus final
examination score. MCQ scores from Thai language examination were more closely correlated with total course grades
than were the scores from English language examination (Spearman’s correlation coefficient = 0.73 (p<0.001) and 0.53
(p<0.001), respectively). The gap difference between MCQ scores in both languages was higher in borderline students than
in the excellent student group (11.2±11.2 and 7.1±8.2, respectively, p<0.001). Overall, average student English proficiency
score was very high, at 3.71±0.35 from a total of 4.00. Mean student GPA was 3.40±0.33 from a possible 4.00. English
language MCQ examination scores were more highly associated with GPA than with English language proficiency.
Conclusion : The use of English language multiple choice question test may decrease scores of the fourth-year internal
medicine post-rotation final examination, especially those of borderline students.
Keywords : Effect of English language, Multiple choice question scores, Thai medical students
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