Images in Assessment

Thought and care should be taken when using images in medical education assessment.

An example of an image used in assessment of anatomy knowledge, from Vorstenbosch et al 2013.
An example of an image used in assessment of anatomy knowledge, from Vorstenbosch et al 2013.

The use of images in assessment can increase the difficulty of some questions, and lower the difficulty and discriminating power in others, depending upon the type and complexity of images that are chosen (Vorstenbosh et al 2013). Surprisingly, the use of images in assessment has received almost no previous attention in scholarly work and as our media become increasingly digital the use of images is likely to increase. Vorstenbosh and colleagues have provided an important contribution to an area that requires much more attention.

The use of images in assessment as stimulus format (questions) is an area that can use additional attention.  Another area for further examination is  how images (drawings) are used as response format, with students providing drawings as answers. Drawings are visual representations of knowledge that includes spatial and can include descriptive information when labels are included. When is it most appropriate to request a drawing as an answer to a question?  Does a drawing provide unique benefits for assessing some types of knowledge?

Vorstenbosch did not consider the use of drawings in assessment.  Their focus was on the use of images as stimulus format in anatomy assessment.  Surprisingly, they were unable to find any previous published work in how images impact assessment, which suggests their work may become a  starting point in a new field of inquiry.   This area could use more research and Vorstenbosch et al have provided a meaningful contribution.


Vorstenbosch M., Klaassen T., Kooloos J., Bolhuis S., and Laan R. 2013. Do Images Influence Assessment in Anatomy? Exploring the Effect of Images on Item Difficulty and Item Discrimination. Anatomical Sciences Education (6) 29-41.

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