Assessment question characteristics predict medical student performance in general pathology

Tahyna Hernandez, Margret S. Magid, Alexandros D. Polydorides

Research output: Contribution to journalArticlepeer-review


Context.-Evaluation of medical curricula includes appraisal of student assessments in order to encourage deeper learning approaches. General pathology is our institution's 4-week, first-year course covering universal disease concepts (inflammation, neoplasia, etc). Objective.-To compare types of assessment questions and determine which characteristics may predict student scores, degree of difficulty, and item discrimination. Design.-Item-level analysis was employed to categorize questions along the following variables: type (multiple choice question or matching answer), presence of clinical vignette (if so, whether simple or complex), presence of specimen image, information depth (simple recall or interpretation), knowledge density (first or second order), Bloom taxonomy level (1-3), and, for the final, subject familiarity (repeated concept and, if so, whether verbatim). Results.-Assessments comprised 3 quizzes and 1 final exam (total 125 questions), scored during a 3-year period, (total 417 students) for a total 52 125 graded attempts. Overall, 44 890 attempts (86.1%) were correct. In multivariate analysis, question type emerged as the most significant predictor of student performance, degree of difficulty, and item discrimination, with multiple choice questions being significantly associated with lower mean scores (P ¼.004) and higher degree of difficulty (P ¼.02), but also, paradoxically, poorer discrimination (P ¼.002). The presence of a specimen image was significantly associated with better discrimination (P ¼.04), and questions requiring data interpretation (versus simple recall) were significantly associated with lower mean scores (P ¼.003) and a higher degree of difficulty (P ¼.046). Conclusions.-Assessments in medical education should comprise combinations of questions with various characteristics in order to encourage better student performance, but also obtain optimal degrees of difficulty and levels of item discrimination.

Original languageEnglish (US)
Pages (from-to)1280-1288
Number of pages9
JournalArchives of Pathology and Laboratory Medicine
Issue number10
StatePublished - Oct 2021
Externally publishedYes

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Medical Laboratory Technology


Dive into the research topics of 'Assessment question characteristics predict medical student performance in general pathology'. Together they form a unique fingerprint.

Cite this