The modified essay question (MEQ) is one of several tools developed to try and assess this skill .The MEQ is a compromise between the multiple-choice question (MCQ) and the essay.
In conjunction with the promotion of these skills, an effective assessment process is required.
It has long been recognised that in the assessment of clinical competence problem-solving ability has been one of the most difficult areas to measure and quantify .
This study was designed to assess the effectiveness of the MEQ to measure higher-order cognitive skills in an undergraduate institution.
An analysis of multiple-choice questions and modified essay questions (MEQs) used for summative assessment in a clinical undergraduate curriculum was undertaken.
In total, 33 MEQs made up of 146 stages were collected for analysis.
The MEQs were written by at least 12 separate authors using the standard methodology for developing assessments within the faculty.The MCQs had one correct answer and four distractors and were constructed to standard guidelines for MCQ construction [8, 9].In addition, the MEQ components of the Final MB BS examination papers for two consecutive years at the University of Adelaide were analysed.Construction of appropriate MEQs can be difficult  and a major criticism of this form of assessment is that MEQs often do little more than test the candidate's ability to recall a list of facts and frustrate the examiner with a large pile of papers to be hand-marked .Although there is evidence to suggest that well constructed MEQs will test higher order cognitive skills , and that they can test different facets of understanding than MCQs , it is reasonable to ask if MEQ assessments in higher education are well constructed and if they are capable of assessing higher order cognitive skills.MEQs often form a vital component of end-of-course assessments in higher education.It is not clear how effectively these questions assess higher order cognitive skills.It accomplishes this by providing a clinical scenario with a number of steps.Progression through these stages should test the candidate's ability to understand, reason, evaluate and critique.A total of 50 MCQs and 139 stages of MEQs were examined, which came from three exams run over two years.The effectiveness of the questions was determined by two assessors and was defined by the questions ability to measure higher cognitive skills, as determined by a modification of Bloom's taxonomy, and its quality as determined by the presence of item writing flaws. This was similar to the percentage of MCQs testing factual recall.