Abstract
BackgroundThere is a significant body of literature that indicates that the number of options for single-best answer multiple choice questions (MCQs) can be reduced from five to three or four without adversely affecting the quality of the questions and tests. Three or four options equates to two or three distractors respectively.MaintextWhilst these arguments may be true when focusing on psychometric aspects of questions, we should also focus on educational and clinical authenticity aspects of questions. I present reasons for MCQs in tests to have a variable number of options which will usually be more than three, four, or five. These include: decisions related to broad clinical scenarios cannot be limited to a small number of options; options lists should include all possible combinations of option elements; and options that are rarely chosen can provide information regarding students and/or for students.ConclusionFinally, given computer based delivery, longer option lists are not impractical for examinees. In the contexts that are appropriate, it is time to consider a move to adopting appropriate and variable numbers of MCQ options and not be limited to MCQs with three, four or five options.
Highlights
Multiple-choice questions (MCQs) are widely used in assessment within medical education and there are numerous articles comparing the number of response options and distractors [1]
Correspondence: mike.tweed@otago.ac.nz Department of Medicine, University of Otago Wellington, Wellington, New Zealand. With this weight of evidence, why would assessment organisers not consider reducing to three or four options? to the contrary, I propose that assessment organisers consider having a variable number of options, which may mean increasing the number of options for many questions. The basis of this argument is that the evidence to reduce the number of options is based on a psychometric perspective, whereas the argument to have a variable number of options, which can include an increased number of options for many questions, is based on clinical authenticity and educational perspectives
Decisions related to broad clinical scenarios cannot be limited to a small number of options Rarely do the questions faced by a clinicians in practice have exactly three, four or five options [8]
Summary
That many institutions are moving to computer delivery and marking of MCQ examinations, it is time to consider the move to adopting appropriate and variable numbers of MCQ options and not be artificially limited to MCQs with three, four or five options.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
