Louisiana State University Health Sciences Center


Teaching pathology courses to medical students requires showing – and then testing on –images of specimen slides, tissues, and other similar visual material. Clearly, for such an important use, the photographs and drawings must be accurate and of high quality. When teachers lecture in the classroom, they usually project these images on a large screen for all to see. However, when it comes time to test students on what they have learned, the test preparers must find a way to include the photos and drawings in each individual test booklet so students can move through the exam at their own pace.

At Louisiana State University’s Health Sciences Center, Giovanni D. Lorusso, M.D. has been course director for the sophomore pathology course since 1995. Unfortunately, there was no good way to include color images on paper exams without the prohibitive cost of color reproduction.

“Copying 25 pages times 175 [the number of students in the class] times for six exams over a year represents a huge duplicating cost,” said Lorusso. “Then, we’d pick up all these booklets after the exam. We have to destroy them, so you have the shredding expense. It was all very costly.”

When the U.S. Medical Licensing Exam or USMLE began using computerized testing, LSU decided it would follow suit.

Computerizing Exams Expands Testing Capabilities

LSU’s medical school had already set the groundwork for using computerized testing by requiring all students to own laptops. The school’s Computer Assisted Learning Committee sets the specifications for these laptops, ensuring that the computers run the same operating system, the same software, and all on identical hardware. When the LSU course directors selected Questionmark as the software on which to administer exams, this standardization made it easy for a computer support team to install the Questionmark browser on each of the students’ machines.

Lorusso uses Questionmark to deliver pathology exams to all of his 175 students at the same time. On exam day, the students come to the laboratories, plug into the network, and then log on with the Questionmark browser. Using Questionmark offers Lorusso a huge advantage. Instead of trying to reproduce detailed images on test booklets, Lorusso can now put high resolution images on the computerized test. In addition to these static pictures, he also uses video clips and flash animations in the questions. The program enables him to include drag and drop questions that ask students to identify specific spots on a picture or to drag a label to a specified location. None of this would be possible with a paper exam.

Paper exams also limited the possibilities for questions. Now, rather than having four choices on a multiple choice question Lorusso can include as many as nine or ten choices. Questionmark also enables him to include fill-in-the-blank questions that can also be automatically scored, a big time saver. Lorusso and his team learned, however, that they must be careful when creating fill-in questions because the answers can come in various permutations. For example, if the question is, “How many days are there in the week?” the answer could be “7” or “seven.” Now he tries to plan more carefully ahead of time to anticipate the problem.

Using computerized testing also enables LSU to randomize the questions. Every student gets the same exam but all of the questions come in a different order, resulting, essentially, in 175 different tests. Even the choices are randomized. That makes the tests much more secure and greatly reduces the temptation to cheat.


Lorusso believes that using computers can only be justified if computerization meets a specific need not attainable by other means. Using Questionmark more than satisfies that requirement. The computerized tests provide LSU with increased security through randomization while saving the school money by eliminating the enormous amount of paper and printing needed for conventional testing. Now tests are easier to administer and grade and have the added benefit of preparing medical school students for the critical national board tests to come.