A randomized controlled trial comparing instructions regarding unsafe response options in a MCQ examination

Area of Science:

• Medical Education
• Assessment and Evaluation

Background:

• Traditional multiple-choice examination scoring often overlooks incorrect or unsafe responses, potentially encouraging guessing.
• An ideal response strategy balances correct answers with the judicious use of 'don't know' options over incorrect ones.

Purpose of the Study:

• To investigate how different examination instructions affect student response patterns in multiple-choice tests.
• To determine if specific instructions can mitigate guessing and promote more considered answers.

Main Methods:

• Fourth- and fifth-year medical students participated in an optional multiple-choice examination.
• Participants were randomly assigned to one of four instructional groups: standard scoring, alert to unsafe responses, mark deduction for unsafe responses, or correction for guessing.

Main Results:

• Fourth-year students showed increased 'don't know' responses and decreased incorrect answers when alerted to unsafe responses or when marks were deducted.
• Fifth-year students did not exhibit significant differences in response patterns across instruction groups.
• Fifth-year students generally provided more correct and fewer incorrect, unsafe, or 'don't know' responses compared to fourth-year students.

Conclusions:

• Both student year level and specific assessment instructions demonstrably influence response behavior.
• Alerting students to potentially unsafe responses can positively impact answer selection, even without a penalty.
• Mark deduction for incorrect/unsafe responses yielded the most significant changes in student answering strategies, highlighting the power of assessment instructions.