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A medical student with dyslexia claims multiple choice exams discriminate against people with the condition and is taking legal action to prevent their use. But why do people with dyslexia find multiple choice difficult?
Medical schools may have to look at changing their testing systems
Dyslexia is known to cause problems with the way the brain processes words and sequences, and students with the condition are generally granted 25% extra time in exams.
But Naomi Gadian, a second year medical student, is calling for the General Medical Council to scrap multiple choice questions as part of doctors' training.
She says although essays and practicals have not been a problem, multiple choice questions discriminate against people with dyslexia.
"They don't let me express my knowledge.
"In normal day life, you don't get given multiple choice questions to sit. Your patients aren't going to ask you 'here's an option and four answers. Which one is right?'" she says.
So are multiple choice questions particularly difficult for people with dyslexia?
A lot of information in one question can be difficult to remember
Creates visual tracking difficulties
But essays can put pressure on fluent writing skills
Dr John Rack, head of psychology at Dyslexia Action, says people with the condition can find multiple choice questions difficult because of the large amount of information which they have to deal with, all at once.
"Dyslexics often have problems with their 'working memory'," he says, "which is the space where we hold on to information. If there are too many options, it is hard to keep track of them and by the last option, they have forgotten the first."
He says everyone can find this problematic, but those with dyslexia find it harder - especially as they tend to read more slowly.
Sue Flohr at the British Dyslexia Association agrees - and says multiple choice questions can create visual tracking difficulties.
People with dyslexia can have a variety of difficulties
"All dyslexics are different," she says, "but shifting the focus up and down and from left to right [required when answering a multiple choice question] can lead them to read inaccurately - especially if there are lots of possible answers."
She says moving the eye a lot takes people with dyslexia longer to refocus and small boxes, tiny print and "colour" can also be a hindrance.
"Black and white can be difficult," she says, "it is like the piano - it is frequently the worst musical instrument for dyslexics to learn."
The use of multiple choice questions is widespread and it is systematically used in psychometric tests for recruitment onto graduate schemes.
So does the exam system need a shake-up - or does the 25% extra do the job?
Dr Racks thinks the 25% extra time for all exams is a bit of a "knee jerk reaction".
"For the vast majority of people it is a reasonable compensation - because you can't take the whole range of adjustments into consideration and have to go with a rule of thumb," he says.
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He says extra time can be a bit of a mixed blessing for students because they get tired. Different types of support - like online assessments, oral tests, mid-exam breaks - would help.
Ms Flohr agrees: "It's not about changing the whole system, but putting in reasonable adjustments to create an even playing field."
But Dr Rack does not think multiple choice is the worst exam format for those who have dyslexia - and says it is unusual for people to have a particular problem with them.
He says case studies and essays can put pressure on the speed of writing and fluent writing skills such as spelling, structuring and sequencing.
"So long as multiple choice questions are well structured and short, they should be fairly accessible," he says.