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Related Experiment Video

Updated: Feb 27, 2026

Using the Threat Probability Task to Assess Anxiety and Fear During Uncertain and Certain Threat

Using the Threat Probability Task to Assess Anxiety and Fear During Uncertain and Certain Threat

Published on: September 12, 2014

Certainty and safe consequence responses provide additional information from multiple choice question assessments.

M J Tweed¹, S Stein², T J Wilkinson³

¹Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington, 6242, New Zealand. mike.tweed@otago.ac.nz.

BMC Medical Education

|June 30, 2017

Summary

Medical students’ response certainty in multiple-choice questions (MCQ) correlates with correctness and safety. However, high certainty on incorrect answers may indicate unsafe choices, suggesting certainty and consequence offer valuable insights beyond traditional scoring.

Keywords:

Assessment Certainty Consequence Multiple choice question Safety

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Area of Science:

Medical Education
Cognitive Psychology
Clinical Decision-Making

Background:

Effective clinical decision-making requires self-monitoring and awareness of action consequences.
Assessing medical students' self-monitoring abilities can be achieved through multiple-choice questions (MCQ) by evaluating response certainty and avoidance of unsafe options.

Purpose of the Study:

To investigate the relationship between medical students' response certainty, the safety of their incorrect answers, and overall performance in a summative MCQ examination.
To determine if response certainty and consequence provide additional predictive information beyond traditional MCQ scoring.

Main Methods:

Fifth-year medical students (n=330) indicated their certainty for each MCQ response during a summative exam.
Incorrect responses were evaluated by an expert panel for their inherent level of unsafeness (response consequence).
Analyses compared response certainty and consequence across different student performance levels.

Main Results:

Increased certainty in responses correlated with higher odds of being correct and lower odds of providing unsafe answers.
For some student ability groups, high certainty on incorrect responses increased the likelihood of those responses being unsafe.
Students below the standard performance level demonstrated appropriate certainty.

Conclusions:

Response certainty and the consequence of incorrect answers offer valuable information beyond the number of correct responses in MCQs.
Measures of certainty and consequence are relatively independent of traditional scoring and can be particularly useful for students near the pass-fail threshold.
While appropriate certainty was observed, high certainty on incorrect answers, except for the lowest performers, indicated a greater risk of unsafe choices.