Extra time examination conditions and question format: Effects on the performance of UK medical students in a...

Single best answer (SBA) questions are used widely in both undergraduate and postgraduate examinations, while very short answer (VSA) questions enable a more authentic assessment of applied knowledge. Variation in SBA and VSA examination results under standard and extended time conditions remains unclear and warrants investigation to ensure fair and inclusive assessment practices.

We analysed data from a cross-sectional study of 1417 medical students from 20 UK medical schools, who were asked to answer 50 VSA questions, followed immediately by the same 50 questions in SBA question format. 118 of these students had extra time (8.3%), and 1299 students (91.7%) had standard time. Extra time was used as a proxy for the identification of candidates with specific learning differences.

Examinations taken under extra-time conditions had mean scores 2 marks (4 percentage points) lower than those under standard-time conditions for both VSA (p < 0.001) and SBA questions (p < 0.001). The absolute score difference between SBA and VSA formats was the same in both timing conditions: a mean of 10 marks (20 percentage points) lower in VSA compared with SBA questions (p = 0.78).

An awarding gap of 4 percentage points was observed between extra-time and standard-time conditions across both SBA and VSA formats. Importantly, students under extra-time conditions were not further disadvantaged by the VSA format, suggesting that, when carefully designed, VSA questions can be as inclusive as SBA questions. Medical schools should also explore alternative assessment formats to help reduce potential awarding gaps between students with and without specific learning differences.