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Negatively Marked Elimination-Format Multiple-Choice Questions Are Associated with High Cognitive Load and Poor Student Experience Compared to Single Best Answer

Phil Newton Orcid Logo, KATHERINE FURBY, JUDE CAMPBELL, ATHARVA SALVI, GABRIELLA SANTIAGO, MICHAEL CHAU

Medical Science Educator, Volume: 35, Issue: 3, Pages: 1411 - 1422

Swansea University Authors: Phil Newton Orcid Logo, KATHERINE FURBY, JUDE CAMPBELL, ATHARVA SALVI, GABRIELLA SANTIAGO, MICHAEL CHAU

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DOI (Published version): 10.1007/s40670-025-02318-7

Abstract

Multiple-choice questions (MCQs) are a common form of assessment in medical science education. The traditional MCQ format involves students picking a single best answer (SBA) from four or five options. There are concerns about the ability of SBA formats to reward partial knowledge and their suscepti...

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Published in: Medical Science Educator
ISSN: 2156-8650
Published: Springer Nature 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa68891
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spelling 2025-07-08T10:40:10.0175121 v2 68891 2025-02-14 Negatively Marked Elimination-Format Multiple-Choice Questions Are Associated with High Cognitive Load and Poor Student Experience Compared to Single Best Answer 6e0a363d04c407371184d82f7a5bddc8 0000-0002-5272-7979 Phil Newton Phil Newton true false 968581336994e2e49b50c64116f82a5f KATHERINE FURBY KATHERINE FURBY true false 9dee60c2f2954284d617c17302569760 JUDE CAMPBELL JUDE CAMPBELL true false cbb9173840966b58a782423363d0d7a6 ATHARVA SALVI ATHARVA SALVI true false 402b2619fa87319f354717bb5f8dd072 GABRIELLA SANTIAGO GABRIELLA SANTIAGO true false 662e72bbc37d20d3282433e3b32d2cd6 MICHAEL CHAU MICHAEL CHAU true false 2025-02-14 MEDS Multiple-choice questions (MCQs) are a common form of assessment in medical science education. The traditional MCQ format involves students picking a single best answer (SBA) from four or five options. There are concerns about the ability of SBA formats to reward partial knowledge and their susceptibility to guessing. An alternative to SBA is elimination testing (ET), wherein students eliminate all the incorrect answer options, with negative marking to deter guessing. Cognitive load theory (CLT) is an approach to education that prioritises strategies to minimise the amount of unnecessary ‘load’ placed upon working memory. The cognitive load imposed by assessment design has received little attention. We evaluated the cognitive load of SBA and ET MCQ formats, using an online participant pool and a survey of students at a UK Medical School. We found that partial knowledge was rewarded with the ET format. However, students strongly preferred the SBA format and reported both that it was easier and imposed a lower cognitive load. Removing negative marking reduced the cognitive load of ET style questions and improved the student experience, but the improvement was insufficient to change student preference for SBA questions. Journal Article Medical Science Educator 35 3 1411 1422 Springer Nature 2156-8650 Multiple-choice questions; Single best answer; Elimination testing; Cognitive load; Testing effect 1 6 2025 2025-06-01 10.1007/s40670-025-02318-7 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University SU Library paid the OA fee (TA Institutional Deal) Swansea University 2025-07-08T10:40:10.0175121 2025-02-14T09:28:03.6302470 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Phil Newton 0000-0002-5272-7979 1 KATHERINE FURBY 2 JUDE CAMPBELL 3 ATHARVA SALVI 4 GABRIELLA SANTIAGO 5 MICHAEL CHAU 6 68891__33637__7b99a73b0dd3444694914554a6b41625.pdf 68891.VOR.pdf 2025-02-19T11:15:28.1785119 Output 790647 application/pdf Version of Record true © The Author(s) 2025. This article is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). true eng http://creativecommons.org/licenses/by/4.0/
title Negatively Marked Elimination-Format Multiple-Choice Questions Are Associated with High Cognitive Load and Poor Student Experience Compared to Single Best Answer
spellingShingle Negatively Marked Elimination-Format Multiple-Choice Questions Are Associated with High Cognitive Load and Poor Student Experience Compared to Single Best Answer
Phil Newton
KATHERINE FURBY
JUDE CAMPBELL
ATHARVA SALVI
GABRIELLA SANTIAGO
MICHAEL CHAU
title_short Negatively Marked Elimination-Format Multiple-Choice Questions Are Associated with High Cognitive Load and Poor Student Experience Compared to Single Best Answer
title_full Negatively Marked Elimination-Format Multiple-Choice Questions Are Associated with High Cognitive Load and Poor Student Experience Compared to Single Best Answer
title_fullStr Negatively Marked Elimination-Format Multiple-Choice Questions Are Associated with High Cognitive Load and Poor Student Experience Compared to Single Best Answer
title_full_unstemmed Negatively Marked Elimination-Format Multiple-Choice Questions Are Associated with High Cognitive Load and Poor Student Experience Compared to Single Best Answer
title_sort Negatively Marked Elimination-Format Multiple-Choice Questions Are Associated with High Cognitive Load and Poor Student Experience Compared to Single Best Answer
author_id_str_mv 6e0a363d04c407371184d82f7a5bddc8
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author_id_fullname_str_mv 6e0a363d04c407371184d82f7a5bddc8_***_Phil Newton
968581336994e2e49b50c64116f82a5f_***_KATHERINE FURBY
9dee60c2f2954284d617c17302569760_***_JUDE CAMPBELL
cbb9173840966b58a782423363d0d7a6_***_ATHARVA SALVI
402b2619fa87319f354717bb5f8dd072_***_GABRIELLA SANTIAGO
662e72bbc37d20d3282433e3b32d2cd6_***_MICHAEL CHAU
author Phil Newton
KATHERINE FURBY
JUDE CAMPBELL
ATHARVA SALVI
GABRIELLA SANTIAGO
MICHAEL CHAU
author2 Phil Newton
KATHERINE FURBY
JUDE CAMPBELL
ATHARVA SALVI
GABRIELLA SANTIAGO
MICHAEL CHAU
format Journal article
container_title Medical Science Educator
container_volume 35
container_issue 3
container_start_page 1411
publishDate 2025
institution Swansea University
issn 2156-8650
doi_str_mv 10.1007/s40670-025-02318-7
publisher Springer Nature
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
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description Multiple-choice questions (MCQs) are a common form of assessment in medical science education. The traditional MCQ format involves students picking a single best answer (SBA) from four or five options. There are concerns about the ability of SBA formats to reward partial knowledge and their susceptibility to guessing. An alternative to SBA is elimination testing (ET), wherein students eliminate all the incorrect answer options, with negative marking to deter guessing. Cognitive load theory (CLT) is an approach to education that prioritises strategies to minimise the amount of unnecessary ‘load’ placed upon working memory. The cognitive load imposed by assessment design has received little attention. We evaluated the cognitive load of SBA and ET MCQ formats, using an online participant pool and a survey of students at a UK Medical School. We found that partial knowledge was rewarded with the ET format. However, students strongly preferred the SBA format and reported both that it was easier and imposed a lower cognitive load. Removing negative marking reduced the cognitive load of ET style questions and improved the student experience, but the improvement was insufficient to change student preference for SBA questions.
published_date 2025-06-01T07:32:34Z
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