Item and distracter analysis of multiple choice questions (MCQs) from a preliminary examination of undergraduate medical students

Durgesh Prasad Sahoo, Rakesh Singh


Background: Multiple choice questions (MCQs) or Items forms an important part to assess students in different educational streams. It is an objective mode of assessment which requires both the validity and reliability depending on the characteristics of its items i.e. difficulty index, discrimination index and distracter efficiency. To evaluate MCQs or items and build a bank of high-quality test items by assessing with difficulty index, discrimination index and distracter efficiency and also to revise/store or remove errant items based on obtained results.

Methods: A preliminary examination of Third MBBS Part-1 was conducted by Department of Community Medicine undertaken for 100 students. Two separate papers with total 30 MCQs or items and 90 distractors each in both papers were analyzed and compared. Descriptive as well as inferential statistics were used to analyze the data.

Results: The findings show that most of the items were falling in acceptable range of difficulty level however some items were rejected due to poor discrimination index. Overall paper I was found to be more difficult and more discriminatory, but its distractor efficiency was slightly low as compared to paper II.

Conclusions: The analysis helped us in selection of quality MCQs having high discrimination and average difficulty with three functional distractors. This should be incorporated into future evaluations to improve the test score and properly discriminate among the students.


Difficulty index, Discrimination index, Distractor efficiency, Functional distractor, Non-functional distractor

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Hamdorf JM, Hall JC. The development of undergraduate curricula in surgery: I. General issues. Aust N Z J Surg. 2001;71(1):46-51.

Liyanage CAH, Ariyaratne MHJ, Dankanda DHCHP, Deen KI. Multiple choice questions as a ranking tool : a friend or foe ? J Med Educ. 2009;3(1):62-4.

Office of Educational Assessment. Understanding Item,2017. Available at: /assessment/scanning-scoring/scoring/reports/item-analysis/.

Carneson J, Delpierre G, Masters K. Designing and Managing Multiple Choice Questions,2016. Available at: an/mcqman01.html.

Case SM, Swanson DB. The selection of upper and lower groups for the validation of test items. Director. 2002;27(21):112.

Kelley TL. The selection of upper and lower groups for the validation of test items. J Educational psychol. 1939;30(1):17.

Miller MD, Linn RL GN. Measurement and assessment in teaching. Up Saddle River, NJ Prentice Hall. 2009.

Garvin AD, Ebel RL. Essentials of Educational Measurement. Educ Res. 1980;9(9):232.

Singh T, Gupta P SD. Test and item analysis. In: Principles of Medical Education, 3rd ed. New Delhi, Jaypee Brother Med Pub Ltd. 2009:70-7.

Susan Matlock-Hetzel. Basic Concepts in Item and Test Analysis,1997. Available at: tamu/Espy.htm.

Carroll G, Carolina N, Evaluation RG, Carolina E. Evaluation for testing of vignette-type examination medical physiology student. 1993;264.

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):40.

Hingorjo MR, Jaleel F. Analysis of one-best MCQs: the difficulty index, discrimination index and distractor efficiency. J Pak Med Assoc. 2012;62(2):142-7.

Crooks TJ. The Impact of Classroom Evaluation Practices on Students. Am Educ Res Assoc. 2016;58(4):438-81.

Kumar P, Sharma R, Rana M, Gajjar S. Item and test analysis to identify quality multiple choice questions (MCQS) from an assessment of medical students of Ahmedabad, Gujarat. Indian J Community Med. 2014;39(1):17.

Pande SS, Pande SR, Parate VR, Nikam AP, Agrekar SH. Correlation between difficulty and discrimination indices of MCQs in formative exam in physiology. South-East Asian J Med Educ. 2013;7(1):45-50.

Guilbert J, Organization WH. Educational Handbook for Health Personnel Sixth Edition. World Health. 1987.

Rodriguez MC. Three options are optimal for multiple-choice items: A meta- analysis of 80 years of research. Educ Meas Is Pract. 2005;24(2):3-13.