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Certainty-based marking in multiple-choice assessments in physiology: a web-based implementation using an AI

Chinmay Suryavanshi¹, Kirtana Raghurama Nayak^1,2

¹Department of Physiology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India.

Advances in Physiology Education

|October 17, 2025

Summary

Certainty-based marking (CBM) in physiology education improved student performance and metacognitive skills. This AI-assisted assessment tool enhanced self-assessment and learning awareness in medical students.

Keywords:

artificial intelligence assessment certainty-based marking large language model metacognitive awareness

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Area of Science:

Medical Education
Educational Technology

Background:

Certainty-based marking (CBM) enhances self-assessment and metacognitive awareness.
Implementing CBM in physiology assessments can improve learning outcomes.

Purpose of the Study:

To explore the implementation of CBM in multiple-choice assessments for first-year medical students in physiology.
To evaluate the impact of CBM on student performance, self-assessment, and metacognitive awareness.

Main Methods:

A web-based CBM assessment tool was developed with AI assistance (Claude 3.5).
15 MCQs were administered as pretest and posttest to 195 first-year medical students.
Student performance, certainty indices, and perceptions were analyzed via surveys.

Main Results:

Significant improvements in performance and certainty indices were observed from pretest to posttest.
Most students found the certainty scale beneficial, leading to answer revisions and better knowledge gap recognition.
Students reported increased metacognitive awareness, self-monitoring skills, and preferred CBM over traditional MCQs.

Conclusions:

AI-assisted CBM functions as both an assessment and instructional tool, enhancing metacognitive awareness and self-monitoring in physiology education.
CBM shows promise for improving knowledge retention and certainty calibration, but longitudinal studies are needed.
AI integration in assessment design offers potential for improving educational strategies and accessibility.