Negatively Marked Elimination-Format Multiple-Choice Questions Are Associated with High Cognitive Load and Poor...

Area of Science:

• Medical Education
• Cognitive Psychology
• Assessment Design

Background:

• Multiple-choice questions (MCQs) are standard in medical education, typically using single best answer (SBA) formats.
• Concerns exist regarding SBA's ability to assess partial knowledge and its susceptibility to guessing.
• Elimination testing (ET) is an alternative MCQ format that penalizes incorrect answers to deter guessing.

Purpose of the Study:

• To evaluate the cognitive load associated with SBA and ET MCQ formats.
• To compare the effectiveness of SBA and ET in rewarding partial knowledge.
• To understand student preferences and perceptions of cognitive load for different MCQ formats.

Main Methods:

• An online participant pool and a survey of UK Medical School students were used.
• The study compared the cognitive load and knowledge assessment capabilities of SBA and ET MCQ formats.
• Variations of ET, including the removal of negative marking, were examined.

Main Results:

• The ET format demonstrated a greater ability to reward partial knowledge compared to SBA.
• Students overwhelmingly preferred the SBA format, reporting it as easier and imposing lower cognitive load.
• Removing negative marking from ET questions reduced cognitive load and improved student experience but did not alter format preference.

Conclusions:

• While ET MCQs may better assess partial knowledge, student preference and perceived cognitive load favor traditional SBA formats.
• Assessment designers should consider both psychometric properties and student experience when choosing MCQ formats.
• Further research is needed to optimize ET formats or bridge the gap in student perception and preference.