{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T19:08:58Z","timestamp":1784833738504,"version":"3.55.0"},"reference-count":20,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Multiple-choice questions (MCQs) are widely used in medical education, but are criticized for cueing and guessing. Very short answer questions (VSAQs), which require students to generate responses independently, may better assess knowledge. While VSAQs demonstrate higher item discrimination within individual exams, their effectiveness in distinguishing academic performance across multiple assessments remains unclear \u2013 representing a key gap in the validation of VSAQs under Messick\u2019s framework, specifically the category of \u201c\n                      <jats:italic>relations to other variables<\/jats:italic>\n                      \u201d. This study examines whether VSAQs or MCQs more effectively distinguish students of varying performance levels across multiple summative examinations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed retrospective data from six mixed-format examinations with VSAQs and MCQs of three cohorts of first- and second-year medical students. Academic performance was measured using grade point average (GPA) across assessments. Linear regression assessed the relationship of each question format with GPA, while ROC curves and C-statistics evaluated their ability to identify poor and excellent performing students (lowest and highest quintile of GPA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      VSAQs showed higher item discrimination (R\n                      <jats:sub>ir<\/jats:sub>\n                      -values) than MCQs in all exams. VSAQs also had a stronger positive association with GPA compared to MCQs, and higher C-statistics, indicating superior discriminative ability.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>VSAQs outperform MCQs in distinguishing academic performance levels across multiple assessments. Their integration into examinations enhances discriminative ability and may facilitate earlier identification of poor and excellent performing students, enabling targeted interventions and support of students.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0349318","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T18:57:04Z","timestamp":1784833024000},"page":"e0349318","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Identifying academic success and underperformance: The discriminative power of very short answer questions and multiple-choice questions"],"prefix":"10.1371","volume":"21","author":[{"given":"Elise V.","family":"van Wijk","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0518-4403","authenticated-orcid":true,"given":"Floris M.","family":"van Blankenstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bastian N.","family":"Ruijter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5721-2715","authenticated-orcid":true,"given":"Jos H. T.","family":"Rohling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jolein","family":"van der Kraan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friedo W.","family":"Dekker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1627-4324","authenticated-orcid":true,"given":"Alexandra M. J.","family":"Langers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"issue":"3","key":"pone.0349318.ref001","doi-asserted-by":"crossref","first-page":"125","DOI":"10.4103\/2230-8229.97543","article-title":"Guidelines for the construction of multiple choice questions tests","volume":"13","author":"MO Al-Rukban","year":"2006","journal-title":"J Family Community Med"},{"key":"pone.0349318.ref002","first-page":"65","article-title":"Written assessment","volume-title":"ABC of learning and teaching in medicine","author":"LWT Schuwirth","year":"2017"},{"issue":"3","key":"pone.0349318.ref003","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1007\/s10459-023-10266-3","article-title":"An experimental comparison of multiple-choice and short-answer questions on a high-stakes test for medical students","volume":"29","author":"J Mee","year":"2024","journal-title":"Adv Health Sci Educ Theory Pract"},{"issue":"9","key":"pone.0349318.ref004","article-title":"Comparing single-best-answer and very-short-answer questions for the assessment of applied medical knowledge in 20 UK medical schools: Cross-sectional study","volume":"9","author":"AH Sam","year":"2019","journal-title":"BMJ Open"},{"issue":"7","key":"pone.0349318.ref005","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0288558","article-title":"Use of very short answer questions compared to multiple choice questions in undergraduate medical students: An external validation study","volume":"18","author":"EV van Wijk","year":"2023","journal-title":"PLoS One"},{"issue":"4","key":"pone.0349318.ref006","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1111\/medu.13504","article-title":"Very-short-answer questions: reliability, discrimination and acceptability","volume":"52","author":"AH Sam","year":"2018","journal-title":"Med Educ"},{"key":"pone.0349318.ref007","doi-asserted-by":"crossref","first-page":"943","DOI":"10.2147\/AMEP.S197977","article-title":"Very Short Answer Questions: A Novel Approach To Summative Assessments In Pathology","volume":"10","author":"AH Sam","year":"2019","journal-title":"Adv Med Educ Pract"},{"key":"pone.0349318.ref008","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1037\/0003-066X.50.9.741","article-title":"Validity of psychological assessment: validation of inferences from persons\u2019 responses and performances as scientific inquiry into score meaning","volume":"50","author":"S Messick","year":"1995","journal-title":"Am Psychol"},{"key":"pone.0349318.ref009","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1007\/S40037-013-0068-X","article-title":"Multiple choice questions are superior to extended matching questions to identify medicine and biomedical sciences students who perform poorly","volume":"2","author":"TMH Eijsvogels","year":"2013","journal-title":"Perspect Med Educ"},{"issue":"5","key":"pone.0349318.ref010","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1016\/S0046-8177(97)90073-3","article-title":"The virtues of extended matching and uncued tests as alternatives to multiple choice questions","volume":"28","author":"BA Fenderson","year":"1997","journal-title":"Hum Pathol"},{"issue":"7","key":"pone.0349318.ref011","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1080\/01421590701746983","article-title":"The CanMEDS initiative: implementing an outcomes-based framework of physician competencies","volume":"29","author":"JR Frank","year":"2007","journal-title":"Med Teach"},{"key":"pone.0349318.ref012","author":"Paragin"},{"key":"pone.0349318.ref013","author":"L Schuwirth","year":"2014"},{"issue":"1","key":"pone.0349318.ref014","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1111\/j.1365-2923.2009.03425.x","article-title":"A primer on classical test theory and item response theory for assessments in medical education","volume":"44","author":"AF De Champlain","year":"2010","journal-title":"Med Educ"},{"key":"pone.0349318.ref015","article-title":"A century of grading research","author":"SM Brookhart","year":"2016","journal-title":"Rev Educ Res"},{"key":"pone.0349318.ref016","article-title":"Defining and measuring academic success","volume":"20","author":"TT York","year":"2015","journal-title":"Pract Assess Res Eval"},{"issue":"1","key":"pone.0349318.ref017","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1186\/s12909-016-0793-z","article-title":"Validity of very short answer versus single best answer questions for undergraduate assessment","volume":"16","author":"AH Sam","year":"2016","journal-title":"BMC Med Educ"},{"issue":"1","key":"pone.0349318.ref018","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1111\/j.1365-2923.1996.tb00716.x","article-title":"A closer look at cueing effects in multiple-choice questions","volume":"30","author":"LW Schuwirth","year":"1996","journal-title":"Med Educ"},{"issue":"3","key":"pone.0349318.ref019","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1111\/medu.12296","article-title":"The impact of cueing on written examinations of clinical decision making: a case study","volume":"48","author":"I Desjardins","year":"2014","journal-title":"Med Educ"},{"issue":"11","key":"pone.0349318.ref020","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1080\/0142159X.2021.1935831","article-title":"Thinking differently - Students\u2019 cognitive processes when answering two different formats of written question","volume":"43","author":"AH Sam","year":"2021","journal-title":"Med Teach"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0349318","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T18:57:07Z","timestamp":1784833027000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0349318"}},"subtitle":[],"editor":[{"given":"Mukhtiar","family":"Baig","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":20,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0349318","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]}}}