Developing a Blueprint for Theoretical Assessment of Biochemistry of Phase I MBBS Students

Here, we have systematically developed a blueprint for the biochemistry theory assessment of phase I MBBS students in India which we have been using for both formative and summative assessments for the past 2 academic years. The blueprint has ensured the content validity and construct reliability and fairness of the assessment.

Medical education in India is currently undergoing a transformation following the introduction of a competency-based curriculum for the MBBS course implemented in August 2019. The topic-wise competencies are clearly spelled out facilitating the framing of appropriate learning objectives. The learning domains according to Bloom's taxonomy and levels of competencies according to Miller's pyramid are also defined in the curriculum. However, the corresponding teaching learning and assessment methods are broadly suggested. As assessment drives learning, the present curriculum is lacking a systematic framework of assessment for ensuring content validity and construct reliability. Blueprinting of the assessment is, therefore, crucial to bridge this gap. Several methodologies have been suggested to develop assessment blueprints for individual subjects [1]. The majority of these methodologies suggest first defining the frequency of occurrence and clinical impact on individual topics and thereby giving weightage. However, for a preclinical subject like biochemistry where many topics do not directly relate to one particular clinical condition, this approach cannot be followed. As opposed to other countries like the USA, in India, preclinical subjects like biochemistry are taught during the medical school years in the MBBS program. Other methodologies (https:// www. nbme. org/ sites/ defau lt/ files/ 2020-01/ Test-Bluep rinti ng-Lesson-2. pdf) have suggested replacing frequency with a number of classes for each topic and clinical impact with the perceived clinical importance of the topic [2]. Though partial blueprints are available in the literature for preclinical subjects like anatomy [3], for biochemistry, there is no assessment blueprint available for theory. Therefore, the current work was conceived to develop a blueprint for theory assessment in biochemistry for phase I MBBS students of our Institute of National Importance. However, our aspirations are definitely there for its potential extrapolation across medical colleges in India.
Following the familiarization of the departmental faculty members, a departmental committee was formed with all the stakeholders. As the institute was one of the Institutes of National Importance, the curriculum adopted was different from other competency-based curricula. The following methodology was followed for developing a blueprint for the biochemistry theory assessment: Step 1. Depending on the number of hours allotted to biochemistry, the teaching hours were divided among the topics. As the total theory hours were 100, the assigned hours were the same as percentages. 2.
Step 2. Next, the frequency for each topic was defined on a scale of 1 to 3 in terms of the number of hours allotted using the following scheme: 1 to 2 h, frequency 1; 3 to 5 h, frequency 2; and 6 to 7 h, frequency 3. 3.
Step 3. The clinical impact for each topic was assigned on a scale of 1 to 3 through consensus among the faculty members using the following scheme: purely basic science topic with minimal direct application to public health, impact 1; topics with moderate application to Table 1 Detailed blueprint for papers I and II public health, impact 2; and topics related to nutrition, mechanism of drug action, the pathogenesis of common lifestyle diseases, organ function tests, etc. which have a high impact on public health, impact 3. 4.

Topic
Step 4. The factor was calculated for each topic by multiplying the frequency with impact. The total factor for all the topics was calculated. 5.
Step 5. The basis point for each topic was calculated by dividing the topic factor by the total factor and then multiplying by 200 (the total theory marks). The basis point was rounded off to remove decimal places and then adjusted to allot actual marks to each topic. 6.
Step 6. Marks for each topic were divided into MCQ (1.5 marks), matching (4 marks), reasoning (5 marks), and case-based questions (5 marks) depending upon the learning outcome to be assessed.
The blueprint developed by this six-step approach was used to develop a model theory question paper which was given to the residents for an answer. After incorporating minor changes suggested by the residents, the blueprint was used to develop a formative assessment for 2 consecutive assessment years. Informal feedback was collected from the phase I MBBS students regarding the pros and cons of the question paper after each assessment. Content validity of the blueprint items was ensured by maintaining a content validity‫‬ ratio of 0.5 or more. Construct reliability was calculated using item analysis by Kuder-Richardson Formula 20 (KR-20) and found to be 0.65 for the first formative assessment. We plan to measure the construct validity by the multitrait-multimethod matrix in a future study as we collect more data on different assessment blueprints on the same set of students.
Using the above six-step approach, it was found that the factor calculated for the topics ranged from 1 to 9 and the total factor was 113. It was also observed that maximum marks were assigned to topics related to metabolism and enzymes which form the core of the biochemistry curriculum. The detailed blueprint for papers I and II is presented in Table 1.
Model question papers made using this blueprint are available in the below weblinks: The informal feedback received from the learners and facilitators showed satisfaction with the topic coverage and fairness of the assessment.