Assessment is a central tool that drives and shapes student learning. The totals of assessments are many, and MCQs are the most accepted and widely used. <br />MCQs are advantageous in assessing a large amount of knowledge. Moreover, well-constructed MCQs can assess higher knowledge domains, such as application, analysis, and synthesis.<br /> MCQs can be marked automatically. However, its limitations were reported as the relative difficulty in their construction and time consuming, cues, and technical errors. <br />Furthermore, some authors consider MCQs as multiple-guess items or are only capable of assessing factual information and are ill-suited for testing higher domains. <br />It was reported that well-written MCQs through a multistep preparation process could evaluate higher domains such as knowledge application, synthesis, and interpretation of clinical knowledge.<br />In pharmacy schools across the U.S, faculty strive to ensure that students are achieving course outcomes. The Accreditation Council for Pharmacy Education (ACPE) provides standards pertaining to student learning and assessment of learning. Standard 11 (Teaching and Learning Methods) states that we must foster the “development and maturation of critical thinking and problem-solving skills” in our students. Standard 15 (Assessment and Evaluation of Student Learning and Curricular Effectiveness) mandates that we assess this higher level learning with methods that “employ a variety of valid and reliable measures systematically and sequentially throughout the professional degree program.” The challenge is to appropriately develop courses so that assessment methods adequately measure the higher level abilities as well as knowledge. Faculty should develop a process by which a variety of cognitive levels are evaluated during testing. <br />One method for characterizing levels of learning was defined in the 1950’s by educational psychologist Benjamin Bloom. In his work, Bloom proposed six hierarchical and cumulative levels of student learning. Lower levels of learning focus on recall of information while middle levels require application of knowledge. Higher thinking levels involve the deconstruction and construction of concepts. <br />Applying this model to testing can be helpful in evaluating student performance at various cognitive levels. <br />If appropriately constructed, multiple choice questions (MCQs) may also assess performance at higher levels, but specific efforts must be taken to ensure the targeting of various cognitive levels. The advantages and disadvantages of MCQs should be weighed when deciding their role in a course assessment plan. Perhaps the most common reason for their use is quick and objective grading. Electronic course management systems also facilitate accurate and timely recording of scores. In addition, the same question can be re-administered to reassess or compare performance of individuals or groups. <br />While administration of MCQs may be simple, development of high quality questions requires a significant time investment, with one author estimating 1 hour per question. Because there are a limited number of choices, a correct answer does not necessarily assure student understanding.<br />However, several publications have documented that MCQs can successfully be used to test at higher cognitive levels. Moreover, MCQs have been shown to be comparable to essay questions when used for higher order testing. Therefore, MCQs may be able to play a role in assessing students’ performance at a variety of levels, if deliberately incorporated into a course assessment plan<br />In conclusion it is not the method for students assessment matters most but rather it is the context of the exam. As students progress through the curriculum, faculty may need to find ways to promote recall knowledge for more advanced topics while continuing to develop their ability to apply and analyze information. Exams with well-designed MCQs that prospectively target various cognitive levels can facilitate assessment of student performance.<br /><br />Al-Mustaqbal University, the number one university in Iraq College of Pharmacy, the top among private colleges<br />