
Reducing the Number of Distractors in Multiple-Choice Questions: A Randomized Study in Undergraduate Medical Education
References
- Tarrant M, Ware J, Mohammed AM. An assessment of functioning and non-functioning distractors in multiple-choice questions: A descriptive analysis. BMC Med Educ. 2009;9(1). DOI: 10.1186/1472-6920-9-40
- Tarrant M, Knierim A, Hayes SK, Ware J. The frequency of item writing flaws in multiple-choice questions used in high stakes nursing assessments. Nurse Educ Today. 2006 Dec;26(8):662–671. DOI: 10.1016/j.nedt.2006.07.006
- Rodriguez MC. Three options are optimal for multiple-choice items: A meta-analysis of 80 years of research. Educational Measurement: Issues and Practice. 2005 Jun;24(2):3–13. DOI: 10.1111/j.1745-3992.2005.00006.x
- Haladyna TM, Downing SM, Rodriguez MC.
A review of multiple-choice item-writing guidelines for classroom assessment . Applied Measurement in Education. Lawrence Erlbaum Associates Inc.; 2002;15(3):309–334. DOI: 10.1207/S15324818AME1503_5 - Fozzard N, Pearson A, Du Toit E, Naug H, Wen W, Peak IR. Analysis of MCQ and distractor use in a large first year Health Faculty Foundation Program: Assessing the effects of changing from five to four options. BMC Med Educ. 2018 Nov 7;18(1). DOI: 10.1186/s12909-018-1346-4
- Coughlin PA, Featherstone CR.
How to Write a High Quality Multiple Choice Question (MCQ): A Guide for Clinicians . Vol. 54, European Journal of Vascular and Endovascular Surgery. W.B. Saunders Ltd; 2017;654–658. DOI: 10.1016/j.ejvs.2017.07.012 - Iñarrairaegui M, Fernández-Ros N, Lucena F, Landecho MF, García N, Quiroga J, et al. Evaluation of the quality of multiple-choice questions according to the students’ academic level. BMC Med Educ. 2022 Dec 1;22(1). DOI: 10.1186/s12909-022-03844-3
- Hernandez T, Magid MS, Polydorides AD. Assessment question characteristics predict medical student performance in general pathology. Arch Pathol Lab Med. 2021 Oct 1;145(10):1280–1288. DOI: 10.5858/arpa.2020-0624-OA
- Downing SM, Juul D, Park YS.
Statistics of testing (chapter 5) . In: Assessment in Health Professions Education. 2nd ed. New York; 2019. pp. 70–85. DOI: 10.4324/9781315166902-5 - Raymond MR, Stevens C, Bucak SD. The optimal number of options for multiple-choice questions on high-stakes tests: application of a revised index for detecting nonfunctional distractors. Advances in Health Sciences Education. 2019 Mar 1;24(1):141–150. DOI: 10.1007/s10459-018-9855-9
- Jiang M, McLaughlin JE. Item Discrimination, Difficulty, and Response Time for 4-Option Multiple Choice Questions Versus 3-Option Multiple Choice Questions. Am J Pharm Educ. 2025 May 1;89(5). DOI: 10.1016/j.ajpe.2025.101408
- Al-lawama M, Kumwenda B. Decreasing the options’ number in multiple choice questions in the assessment of senior medical students and its effect on exam psychometrics and distractors’ function. BMC Med Educ. 2023 Dec 1;23(1). DOI: 10.1186/s12909-023-04206-3
- Chauhan GR, Chauhan BR, Vaza JV, Chauhan PR. Relations of the Number of Functioning Distractors With the Item Difficulty Index and the Item Discrimination Power in the Multiple Choice Questions. Cureus. 2023 Jul 26. DOI: 10.7759/cureus.42492
- Murias Quintana E, Rodríguez Castro J, Sánchez Lasheras F, Vega Villar J, Curbelo García JJ, Cadenas Rodríguez M, et al. Improving the ability to discriminate medical multiple-choice questions through the analysis of the competitive examination to assign residency positions in Spain. BMC Med Educ. 2024 Dec 1;24(1). DOI: 10.1186/s12909-024-05324-2
- Sridharan K, Sivaramakrishnan G. Less is more? A systematic review and network meta-analysis on MCQ option numbers. BMC Med Educ. 2025 Dec 1;25(1). PubMed PMID: 41102708. DOI: 10.1186/s12909-025-08026-5
DOI: https://doi.org/10.5334/pme.2583 | Journal eISSN: 2212-277X
Language: English
Submitted on: Mar 19, 2026
Accepted on: Mar 26, 2026
Published on: Apr 22, 2026
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year
© 2026 Patricia Sunsundegui, Marcos Llorente-Ortega, Felipe Lucena, Nerea Fernández-Ros, Maite Solas, Ana Belén Alcaide, Manuel F. Landecho, Jorge Quiroga, Mercedes Iñarrairaegui, José Ignacio Herrero, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.