{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T23:21:56Z","timestamp":1773357716121,"version":"3.50.1"},"reference-count":47,"publisher":"Ubiquity Press, Ltd.","issue":"1","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Perspect Med Educ"],"abstract":"<jats:p>Current evaluations of generative artificial intelligence (GenAI) in item-writing within medical education often concentrate on isolated dimensions such as validity or reliability, overlooking the broader theoretical foundations that underpin a trustworthy assessment design. This narrow emphasis risks oversimplifying GenAI\u2019s role and obscuring how its adoption reshapes the relationship between quality, efficiency, and educational value. To address this complexity, this paper presents the Co-Created SBA Design (CCSD) framework, which reconceptualises assessment theory for the GenAI era through the lens of Van der Vleuten\u2019s Utility Index. The framework offers a coherent structure for integrating GenAI into Single Best Answer development, maintaining equilibrium across the Utility Index dimensions while redefining collaboration among educators, higher education institutions, and GenAI, a technological partner that enriches the item-writing process. Within this triadic model, each contributor plays a distinct yet complementary role in sustaining assessment quality. Collectively, their interaction ensures that validity, reliability, educational impact, acceptability, and cost-efficiency remain balanced, supporting both educational integrity and sustainable innovation in medical education.<\/jats:p>","DOI":"10.5334\/pme.2033","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T12:31:09Z","timestamp":1773318669000},"page":"239-250","source":"Crossref","is-referenced-by-count":0,"title":["When Assessment Theory Meets Generative AI: Reimagining SBA Design in Medical Education"],"prefix":"10.5334","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8152-5639","authenticated-orcid":false,"given":"Nora","family":"Al-Shawee","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0152-4370","authenticated-orcid":false,"given":"Gerry","family":"McElvaney","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1876-8790","authenticated-orcid":false,"given":"Judith","family":"Strawbridge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9760-0544","authenticated-orcid":false,"given":"Muirne","family":"Spooner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3285","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"issue":"8","key":"key20260312123132_B1","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1080\/01421590400013495","article-title":"Improving the fairness of multiple-choice questions: A literature review","volume":"26","year":"2004","journal-title":"Med Teach"},{"issue":"1","key":"key20260312123132_B2","article-title":"Applying the utility index to review single best answer questions in medical education assessment","volume":"2","year":"2020","journal-title":"Archives of Epidemiology and Public Health"},{"issue":"1","key":"key20260312123132_B3","article-title":"Barriers and facilitators to writing quality items for medical school assessments \u2013 a scoping review","volume":"19","year":"2019","journal-title":"BMC Med Educ"},{"issue":"1","key":"key20260312123132_B4","article-title":"Large language models for generating medical examinations: Systematic review","volume":"24","year":"2024","journal-title":"BMC Med Educ"},{"issue":"1","key":"key20260312123132_B5","article-title":"Quality assurance and validity of ai-generated single best answer questions","volume":"25","year":"2025","journal-title":"BMC Med Educ"},{"issue":"1","key":"key20260312123132_B6","article-title":"Comparison of ai-generated and clinician-designed multiple-choice questions in emergency medicine exam: A psychometric analysis","volume":"25","year":"2025","journal-title":"BMC Med Educ"},{"key":"key20260312123132_B7","first-page":"1","article-title":"Gpt-4 versus human authors in clinically complex mcq creation: A blinded analysis of item quality","year":"2025","journal-title":"Med Teach"},{"issue":"1","key":"key20260312123132_B8","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/BF00596229","article-title":"The assessment of professional competence: Developments, research and practical implications","volume":"1","year":"1996","journal-title":"Adv Health Sci Educ"},{"key":"key20260312123132_B9","doi-asserted-by":"crossref","first-page":"53","DOI":"10.5116\/ijme.4dfb.8dfd","article-title":"Making sense of cronbach\u2019s alpha","volume":"2","year":"2011","journal-title":"Int J Med Educ"},{"issue":"10","key":"key20260312123132_B10","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1080\/0142159X.2021.1957088","article-title":"Ottawa 2020 consensus statement for programmatic assessment \u2013 1. 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