Multiple-choice Examination Research Articles

Strengthening the Multiple-Choice Assessment: Improving Item-Writing Skills of Physician Assistant Educators.

Physician assistant (PA) educators are tasked with the challenging privilege of ensuring future PAs are knowledgeable and competent to practice medicine. Most enter academia without formal education in providing education. They learn as they go-a treacherous and steep learning curve. This study provides PA educators literature and skills to bolster the strength and validity of multiple-choice examination items to measure learner progress and identify knowledge gaps. Skills can be improved at the level of the individual educator and program or institution. Approaching item writing and item revision in a stepwise, evidence-based manner can improve the quality of the items, strengthening multiple-choice examinations. This process can yield improved assessments of students' medical knowledge and competence. This study aims to provide the PA educator with techniques to improve their item-writing skills.

Large Language Model Influence on Diagnostic Reasoning

Large language models (LLMs) have shown promise in their performance on both multiple-choice and open-ended medical reasoning examinations, but it remains unknown whether the use of such tools improves physician diagnostic reasoning. To assess the effect of an LLM on physicians' diagnostic reasoning compared with conventional resources. A single-blind randomized clinical trial was conducted from November 29 to December 29, 2023. Using remote video conferencing and in-person participation across multiple academic medical institutions, physicians with training in family medicine, internal medicine, or emergency medicine were recruited. Participants were randomized to either access the LLM in addition to conventional diagnostic resources or conventional resources only, stratified by career stage. Participants were allocated 60 minutes to review up to 6 clinical vignettes. The primary outcome was performance on a standardized rubric of diagnostic performance based on differential diagnosis accuracy, appropriateness of supporting and opposing factors, and next diagnostic evaluation steps, validated and graded via blinded expert consensus. Secondary outcomes included time spent per case (in seconds) and final diagnosis accuracy. All analyses followed the intention-to-treat principle. A secondary exploratory analysis evaluated the standalone performance of the LLM by comparing the primary outcomes between the LLM alone group and the conventional resource group. Fifty physicians (26 attendings, 24 residents; median years in practice, 3 [IQR, 2-8]) participated virtually as well as at 1 in-person site. The median diagnostic reasoning score per case was 76% (IQR, 66%-87%) for the LLM group and 74% (IQR, 63%-84%) for the conventional resources-only group, with an adjusted difference of 2 percentage points (95% CI, -4 to 8 percentage points; P = .60). The median time spent per case for the LLM group was 519 (IQR, 371-668) seconds, compared with 565 (IQR, 456-788) seconds for the conventional resources group, with a time difference of -82 (95% CI, -195 to 31; P = .20) seconds. The LLM alone scored 16 percentage points (95% CI, 2-30 percentage points; P = .03) higher than the conventional resources group. In this trial, the availability of an LLM to physicians as a diagnostic aid did not significantly improve clinical reasoning compared with conventional resources. The LLM alone demonstrated higher performance than both physician groups, indicating the need for technology and workforce development to realize the potential of physician-artificial intelligence collaboration in clinical practice. ClinicalTrials.gov Identifier: NCT06157944.

Evaluation of Skin of Color Curricular Content for Physician Assistant Education.

Physician assistants (PAs) are often members of dermatologic care teams. Adequate knowledge of dermatologic conditions in skin of color (SOC) is crucial to proper diagnosis, treatment, and patient satisfaction. The objective of this study was to increase PA students' objective knowledge of and comfort level with evaluating dermatologic conditions in SOC. Eligible participants included 36 PA students at a major metropolitan medical center during the 2022 to 2023 academic year. A preintervention survey, immediate postintervention survey, and 7-month follow-up postintervention survey were administered before and after a SOC lecture. The surveys concluded with a 10-question, image-based, multiple-choice examination. There was a significant increase in accurate diagnoses of acne scarring, eczema, psoriasis, rosacea, and seborrheic dermatitis in SOC (59.4% preintervention to 76.9% postintervention, P = .029). Student confidence, as rated on a scale of 1 (minimally confident) to 5 (extremely confident), in diagnosing these conditions increased from 2.97 to 3.52 (P = .036). Implementation of a SOC-specific dermatology lecture significantly increased the accuracy and confidence with which PA students diagnosed dermatologic conditions.

Testing the power of Google DeepMind: Gemini versus ChatGPT 4 facing a European ophthalmology examination

PurposeThe aim of this study was to compare the performances of Google Gemini and ChatGPT-4, facing a triple simulation of the European Board of Ophthalmologists (EBO) multiple choices exam. DesignObservational study. MethodsThe EBO multiple choice examination consists of 52 questions followed by 5 statements each, for a total of 260 answers. Statements may be answered with “True”, “False” or “Don't Know”: a correct answer is awarded 1 point; an incorrect is penalized 0.5 points; “don't know” scores 0 points. At least 60 % correct answers are needed to pass the exam. After explaining the rules to the chatbots, he entire question with the 5 statements was input. The rate of correct answers and the final score were collected. The exam simulation was repeated 3 times with randomly generated questions. ResultsGoogle Gemini and ChatGPT-4 succeed in EBO exam simulations in all 3 cases, with an average 85.3 ± 3.1 % and 83.3 ± 2.4 % of correct answers. Gemini had a lower error rate compared to ChatGPT (6.7 ± 1.5 % vs. 13.0 ± 2.6 %, p = 0.03), but answered “Don't know” more frequently (8.0 ± 2.7 % vs. 3.7 ± 1.5 %, p = 0.05). Both chatbots scored at least 70 % of correct answers in each exam subspecialty across the 3 simulations. Converting the percentages into points, Gemini scored 213.5 ± 9.3 points on average, compared to 199.8 ± 7.1 points for ChatGPT (p = 0.21). ConclusionsGoogle Gemini and ChatGPT-4 can both succeed in a complex ophthalmology examination on widespread topics, with higher accuracy compared to their former versions, highlighting their evolving importance in educational and informative setting. PrecisGoogle Gemini and ChatGPT-4 were both able to succeed in 3 consecutive exam simulations of the European Board of Ophthalmologists with an average of 85 % and 83 % correct answers, respectively. Google Gemini showed significantly less errors when compared to ChatGPT.

The Accuracy of Artificial Intelligence ChatGPT in Oncology Examination Questions

The aim of this study is to assess the accuracy of Chat Generative Pretrained Transformer (ChatGPT) in response to oncology examination questions in the setting of one-shot learning. Consecutive national radiation oncology in-service multiple-choice examinations were collected and inputted into ChatGPT 4o and ChatGPT 3.5 to determine ChatGPT’s answers. ChatGPT’s answers were then compared with the answer keys to determine whether ChatGPT correctly or incorrectly answered each question and to determine if improvements in responses were seen with the newer ChatGPT version. A total of 600 consecutive questions were inputted into ChatGPT. ChatGPT 4o answered 72.2% questions correctly, whereas 3.5 answered 53.8% questions correctly. There was a significant difference in performance by question category (P < .01). ChatGPT performed poorer with respect to knowledge of landmark studies and treatment recommendations and planning. ChatGPT is a promising technology, with the latest version showing marked improvement. Although it still has limitations, with further evolution, it may be considered a reliable resource for medical training and decision making in the oncology space.

Use of Multiple-Choice Items in Summative Examinations: Questionnaire Survey Among German Undergraduate Dental Training Programs.

Multiple-choice examinations are frequently used in German dental schools. However, details regarding the used item types and applied scoring methods are lacking. This study aims to gain insight into the current use of multiple-choice items (ie, questions) in summative examinations in German undergraduate dental training programs. A paper-based 10-item questionnaire regarding the used assessment methods, multiple-choice item types, and applied scoring methods was designed. The pilot-tested questionnaire was mailed to the deans of studies and to the heads of the Department of Operative/Restorative Dentistry at all 30 dental schools in Germany in February 2023. Statistical analysis was performed using the Fisher exact test (P<.05). The response rate amounted to 90% (27/30 dental schools). All respondent dental schools used multiple-choice examinations for summative assessments. Examinations were delivered electronically by 70% (19/27) of the dental schools. Almost all dental schools used single-choice Type A items (24/27, 89%), which accounted for the largest number of items in approximately half of the dental schools (13/27, 48%). Further item types (eg, conventional multiple-select items, Multiple-True-False, and Pick-N) were only used by fewer dental schools (≤67%, up to 18 out of 27 dental schools). For the multiple-select item types, the applied scoring methods varied considerably (ie, awarding [intermediate] partial credit and requirements for partial credit). Dental schools with the possibility of electronic examinations used multiple-select items slightly more often (14/19, 74% vs 4/8, 50%). However, this difference was statistically not significant (P=.38). Dental schools used items either individually or as key feature problems consisting of a clinical case scenario followed by a number of items focusing on critical treatment steps (15/27, 56%). Not a single school used alternative testing methods (eg, answer-until-correct). A formal item review process was established at about half of the dental schools (15/27, 56%). Summative assessment methods among German dental schools vary widely. Especially, a large variability regarding the use and scoring of multiple-select multiple-choice items was found.

Mathematics self-concept and response pattern in higher education examinations: differences between genders

The study examined how mathematics self-concept, mathematics anxiety and endorsement of mathematics gender stereotypes may impact female students’ response pattern in multiple-choice examinations in courses with mathematical content. Questionnaires measuring these three variables were completed by 435 undergraduates (327 enrolled in a non-mathematical course and 108 in a course with mathematical content). Achievement was measured via multiple-choice examinations, thus allowing us to analyse students’ response patterns (i.e. not only their mark but also the number of hits, errors and unanswered questions). In females, a poorer mathematics self-concept and higher levels of mathematics anxiety (compared with male classmates) did not impact negatively on their final mark in the course with mathematical content. However, the response pattern in this course differed according to gender and mathematics self-concept: a poorer mathematics self-concept was associated with a higher number of unanswered questions in women and a tendency toward a greater number of errors in men. This suggests that a poorer mathematics self-concept leads women to be more cautious during multiple-choice examinations so as to minimise mistakes, whereas in males it tends to be associated with a risk-taking response strategy. These results raise further concerns about the use of multiple-choice examinations, particularly for assessing mathematical knowledge in students with low mathematics self-concept.

Developing an educational “hub”: impact of a distance-learning curriculum in a multinational cohort

PurposeTo address a gap in radiation oncology education in low- and middle-income countries (LMICs), we sought to evaluate the effectiveness and generalizability of a refined curriculum on intensity modulated radiotherapy (IMRT) offered to existing radiation therapy (RT) clinics across Africa and Latin America (LATAM) at no cost.MethodsA curriculum was created based on prior needs assessments and adapted for participating medical physicists, radiation oncologists, radiation therapists, and trainees in LMICs. English-speaking and Spanish-speaking teams of volunteer educators delivered 27 hour-long sessions 1–2 times weekly for 4 months using video conferencing to African and LATAM cohorts, respectively. Pre- and post-course multiple-choice examinations were administered to LATAM participants, and pre- and post-course self-confidence (1–5 Likert-scale) and open-ended feedback were collected from all participants.ResultsTwenty-five centers across Africa (13) and LATAM (12) participated, yielding a total of 332 enrolled participants (128 African, 204 LATAM). Sessions were delivered with a mean of 44 (22.5) and 85 (25.4) participants in the African and LATAM programs, respectively. Paired pre and post-course data demonstrated significant (p < 0.001) improvement in knowledge from 47.9 to 89.6% and self-confidence across four domains including foundations (+ 1.1), commissioning (+ 1.3), contouring (+ 1.7), and treatment planning (+ 1.0). Attendance was a significant predictor of change in self-confidence in “high attendance” participants only, suggesting a threshold effect. Qualitative data demonstrates that participants look forward to applying their knowledge in the clinical setting.ConclusionA specialized radiation oncology curriculum adapted for LMIC audiences was effective for both African and LATAM participants. Participant feedback suggests that the refined IMRT course empowered clinics with knowledge and confidence to help train others. This feasible “Hub and Spokes” approach in which a distance-learning course establishes a hub to be leveraged by spokes (learners) may be generalizable to others aiming to reduce global health care disparities through training efforts.

Android Quiz Application Development

Android bias and technology have become a fundamental part of our lives. Mobile biases are being used as a means of data exchange, converse, entertainment, texting and other social communication, making computers perform the most complex tasks. In the field of the moment today, it is seen that multitudinous people want to test their memory and general knowledge capability. We help them do this with our small Android app that allows them to check their overall command. This paper presents the main way in the development of a quiz operation for Android using Android Studio. This work deals with the development of an Android-predicated multiple-choice question examination system. This operation is developed for educational purposes, allowing stoner to produce multiple-choice questions for different tests.

Can ChatGPT pass the MRCP (UK) written examinations? Analysis of performance and errors using a clinical decision-reasoning framework

ObjectiveLarge language models (LLMs) such as ChatGPT are being developed for use in research, medical education and clinical decision systems. However, as their usage increases, LLMs face ongoing regulatory concerns....

GPT-4 passes the bar exam.

In this paper, we experimentally evaluate the zero-shot performance of GPT-4 against prior generations of GPT on the entire uniform bar examination (UBE), including not only the multiple-choice multistate bar examination (MBE), but also the open-ended multistate essay exam (MEE) and multistate performance test (MPT) components. On the MBE, GPT-4 significantly outperforms both human test-takers and prior models, demonstrating a 26% increase over ChatGPT and beating humans in five of seven subject areas. On the MEE and MPT, which have not previously been evaluated by scholars, GPT-4 scores an average of 4.2/6.0 when compared with much lower scores for ChatGPT. Graded across the UBE components, in the manner in which a human test-taker would be, GPT-4 scores approximately 297 points, significantly in excess of the passing threshold for all UBE jurisdictions. These findings document not just the rapid and remarkable advance of large language model performance generally, but also the potential for such models to support the delivery of legal services in society. This article is part of the theme issue 'A complexity science approach to law and governance'.

Development and evaluation of a novel knowledge assessment tool for pediatric emergency medicine clerkships.

This study seeks to determine validity evidence for a newly developed multiple-choice examination (MCE) tool to assess retention and application of medical knowledge of students enrolled in a pediatric emergency medicine (PEM) clerkship. A team of PEM physicians created a 110-item MCE covering the range of clinical topics in PEM relevant for medical students. The researchers determined examination content using the report of Clerkship Directors in Emergency Medicine and PEM Interest Group of the Society for Academic Emergency Medicine (SAEM). The authors administered the MCE to fourth-year medical students at the end of their PEM rotation from May 2020 to April 2023 at four institutions and then analyzed the examination using four of Messick's five sources of validity evidence: content, response process, internal structure, and relation to other variables. A total of 158 students took the test. In academic year (AY)20-21, 47 students took the test and scored, on average, 81%. After revision of poor and indeterminate questions, the 111 medical students who took the revised version of the test in AY21-AY23 scored on average 77.3% with a standard deviation of 5.7% with a normal distribution in scores. The revised questions were rated as excellent (10.0%), good (26.4%), fair (34.5%), poor (24.5%), or indeterminate (4.5%) based on test item discrimination. There was a positive correlation between MCE scores and students' clinical evaluations but no correlation between MCE scores and scores that students received on their clinical notes or patient presentations during case conference. This novel PEM clerkship examination is a reliable test of medical knowledge. Future directions involve evaluating consequences of the MCE and offering the test to medical students in a dedicated PEM rotation at the national level.

Beyond multiple choice: Clinical simulation as a rigorous and inclusive method for assessing genetic counseling competencies.

Educational use of clinical simulation is a way for students to immerse themselves within a realistic yet safe and structured environment as they practice clinical skills. It is widely used in healthcare training and evaluation, and there are best practices for design, implementation, debriefing, and assessment. An increasing number of genetic counseling graduate programs use simulation in various ways, ranging from role-plays to working with professional simulated/standardized patient (SP) actors. At this time, there is very little consistency across programs, research on the approaches, and standards by which simulation is incorporated into training. Simulation is an understudied but promising approach for genetic counselor (GC) education and assessment. After graduation, GCs demonstrate their competence as entry-level providers through American Board of Genetic Counseling (ABGC) multiple-choice examination (MCE), along with their participatory clinical encounters from graduate training. Data from genetic counseling and other professions highlight the limitations and biases of MCEs, suggesting they not only fail to accurately capture competency, but also that they disadvantage underrepresented individuals from entering the field. In addition, MCEs are limited as a tool for assessing nuanced counseling and communication skills, as compared to more quantitative scientific knowledge. We propose that innovative, evidence-based approaches such as simulation have the potential to not only enhance learning, but also to allow GCs to better demonstrate competency during training and in relation to the board examination. Collaborative approaches, research, and funding are needed to further explore the viability of routinely incorporating simulation into GC training and assessment.

A Novel Evaluation Model for Assessing ChatGPT on Otolaryngology-Head and Neck Surgery Certification Examinations: Performance Study.

ChatGPT is among the most popular large language models (LLMs), exhibiting proficiency in various standardized tests, including multiple-choice medical board examinations. However, its performance on otolaryngology-head and neck surgery (OHNS) certification examinations and open-ended medical board certification examinations has not been reported. We aimed to evaluate the performance of ChatGPT on OHNS board examinations and propose a novel method to assess an AI model's performance on open-ended medical board examination questions. Twenty-one open-ended questions were adopted from the Royal College of Physicians and Surgeons of Canada's sample examination to query ChatGPT on April 11, 2023, with and without prompts. A new model, named Concordance, Validity, Safety, Competency (CVSC), was developed to evaluate its performance. In an open-ended question assessment, ChatGPT achieved a passing mark (an average of 75% across 3 trials) in the attempts and demonstrated higher accuracy with prompts. The model demonstrated high concordance (92.06%) and satisfactory validity. While demonstrating considerable consistency in regenerating answers, it often provided only partially correct responses. Notably, concerning features such as hallucinations and self-conflicting answers were observed. ChatGPT achieved a passing score in the sample examination and demonstrated the potential to pass the OHNS certification examination of the Royal College of Physicians and Surgeons of Canada. Some concerns remain due to its hallucinations, which could pose risks to patient safety. Further adjustments are necessary to yield safer and more accurate answers for clinical implementation.

The effect of the attitude towards risk/ambiguity on examination grades: cross-sectional study in a Portuguese medical school

Given the high prevalence of multiple-choice examinations with formula scoring in medical training, several studies have tried to identify other factors in addition to the degree of knowledge of students which influence their response patterns. This study aims to measure the effect of students’ attitude towards risk and ambiguity on their number of correct, wrong, and blank answers. In October 2018, 233 3rd year medical students from the Faculty of Medicine of the University of Porto, in Porto, Portugal, completed a questionnaire which assessed the student’s attitudes towards risk and ambiguity, and aversion to ambiguity in medicine. Simple and multiple regression models and the respective regression coefficients were used to measure the association between the students’ attitudes, and their answers in two examinations that they had taken in June 2018. Having an intermediate level of ambiguity aversion in medicine (as opposed to a very high or low level) was associated with a significant increase in the number of correct answers and decrease in the number of blank answers in the first examination. In the second examination, high levels of ambiguity aversion in medicine were associated with a decrease in the number of wrong answers. Attitude towards risk, tolerance for ambiguity, and gender did not show significant association with the number of correct, wrong, and blank answers for either examination. Students’ ambiguity aversion in medicine is correlated with their performance in multiple-choice examinations with negative marking. Therefore, it is suggested the planning and implementation of counselling sessions with medical students regarding the possible impact of ambiguity aversion on their performance in multiple-choice questions with negative marking.

Contribution of critical thinking, science process skills towards learning outcomes based on gender

&lt;span lang="EN-US"&gt;The purpose of this study is to ascertain importance of scientific reasoning and process abilities to students’ learning outcomes based on gender differences. This type of research uses the kind of correlation research. This research was carried out for one semester a sample of 104 students studying biology in senior high schools in Sumbawa, Indonesia, with a total of 55 female and 49 male students. In this study, multiple-choice examinations were used to assess the students’ science process skills as well as their critical thinking abilities and learning outcomes. The findings the results of the multiple regression analysis demonstrate that the scientific method and critical thinking abilities are strongly correlated effectively children learn, depending on the gender difference. The importance of critical thinking abilities’ positive effects on learning outcomes of the female students was 81.60% and towards the learning results of the male students was 59.1. The usefulness of the science process skill in terms of practical contribution variable towards the learning results of the female students was 4.5%, and the male students were 20.6%. This means that the average simultaneous is classified as high. However, science process skills’ contribution to learning results is relatively low. The research finding shows that the science process skills have a low effective contribution towards students’ learning results based on gender differences, needs to be a serious concern. That is, implementing the appropriate learning models to enhance the development of science process abilities.&lt;/span&gt;

3D Printed Cardiac Models as an Adjunct to Traditional Teaching of Anatomy in Congenital Heart Disease—A Randomised Controlled Study

Three-dimensional (3D) printed cardiac models are increasingly being used for medical education, simulation and training, communication, surgical planning and research. Given the complexities of congenital cardiac anatomy, 3D printing is well suited as an adjunct to traditional teaching methods. This study aims to explore the influence of 3D printed cardiac models as a teaching aid for nurses and paediatric trainees. We hypothesise that using 3D models as an adjunct to didactic teaching methods improves knowledge and confidence levels of participants, regardless of their cardiology experience. A prospective randomised study was performed recruiting paediatric nurses and doctors at a tertiary paediatric hospital. All participants undertook traditional congenital cardiac teaching describing normal cardiac anatomy and seven congenital lesions of increasing complexity (atrial septal defect, ventricular septal defect, vascular ring, partial anomalous pulmonary venous return, tetralogy of Fallot, transposition of the great arteries, and double outlet right ventricle). The intervention group received an additional recorded demonstration while handling 3D printed models of a normal heart and the same lesions. Pre- and post-intervention assessments were completed using a subjective Likert-scale questionnaire and objective multiple-choice examination. A total of 73 health practitioners (30 cardiac nurses and 43 paediatric trainees) were included. Subjective knowledge and confidence levels substantially improved in the intervention group (both p<0.001), with no differences observed in the control group. Greater improvement in both subjective and objective post-test scores was observed in the intervention group. A pronounced difference between pre- and post-teaching objective examination scores was found in both groups (p=0.002), with larger improvements observed in the intervention group. The mean score in the intervention group after teaching increased by 4.27 (21.4% improvement), as opposed to 2.28 (11.4% improvement) in the control group. There was no difference in pre-test score or post-test improvement based on previous cardiology experience. Three-dimensional (3D) printed cardiac models, when used as an adjunct to traditional teaching methods, substantially improve knowledge and confidence levels of health professionals on a range of congenital cardiac lesions. These models enhance the learners' educational experience and understanding of cardiac anatomy by overcoming the limitation of two-dimensional representations of 3D structures.

A Team-based Learning Approach During Pediatric Clerkship to Promote Clinical Reasoning.

Clinical reasoning skills are essential to medical practice. The problem lies in assuming junior medical students with limited experience develop clinical reasoning and decision-making skills passively and solely through clinical exposure. To prepare learners for independent practice and care for future patients, explicit teaching and assessment of clinical reasoning in low-stakes, collaborative learning environments are needed. The key-feature question (KFQs) format is an assessment approach that focuses on the reasoning and decision-making aspects of medical problems rather than knowledge recall. This report describes the development, implementation, and evaluation of a team-based learning (TBL) approach using KFQs to foster clinical reasoning in the third-year pediatric clerkship at our institution. Over the first 2 years of implementation (2017-18, 2018-19), 278 students participated in TBL sessions. Mean individual student scores significantly improved in the group setting for both academic years (P<.001). Individual scores were moderately positively correlated with their total summative Objective Structured Clinical Examination score (r[275]=0.51; P<.001). The correlation between individual score and their multiple-choice question examination was weaker at 0.29 (P<.001) but remained positive. A TBL session using KFQs to both teach and assess clinical reasoning in clerkship students may help educators identify students with gaps in knowledge and/or reasoning. The next steps include developing and implementing individualized coaching opportunities, and expanding this approach within the undergraduate medical curriculum. Outcome measures to assess clinical reasoning in authentic patient encounters require further research and development.

Comparing the Learning Outcomes of Online versus Face-to-Face Formats in Teaching a Marketing Course: An Empirical Observation

A study was conducted to compare the academic performance of two groups of university students enrolled in the Principles of Marketing course. One group of students participated in an online class, while the other group of students attended a face-to-face class. The results of the study revealed notable differences in academic performance between the two groups. The findings consistently indicated that the online students outperformed their counterparts in the face-to-face class, particularly, in the multiple-choice examinations as well as the essay-problem questions. However, the author of the study highlights a significant factor that readers should consider when interpreting these results. The higher performance demonstrated by online students may be attributed to their demographic and socioeconomic background. It was observed that the online students were significantly older, married, and came from a higher economic status compared to the face-to-face class students. Furthermore, the online students devoted nearly double the amount of time to studying, averaging 6.26 hours per week compared to 3.54 hours for the face-to-face class students in the study.

Gender bias in first-year multiple-choice physics examinations

Gender bias in first-year multiple-choice physics examinations