ArticlePerspectives on medical education2025
The Effect of the Question Mark Option in Progress Testing: A Large-Scale Longitudinal Study.
Article in Perspectives on medical education, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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11 authors.
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Abstract
Introduction: Formula scoring, widely used in medical progress tests (PT), includes a question mark option to discourage guessing, but this feature may disadvantage risk-averse students and bias results due to test-taking strategies. To enhance reliability and more accurately assess ability, Dutch medical schools recently transitioned to a computer adaptive-PT (CA-PT) based on Item Response Theory, which adjusts question difficulty dynamically, excluding the question mark option. This provided a unique opportunity to evaluate the impact of the question mark option in a large cohort. We specifically explored the relationship between question mark use in conventional PT and performance on CA-PT. Methods: Retrospective data from medical students across seven faculties who took both PT formats were analyzed. Z-scores for total score and question mark score (number of unanswered questions) in the conventional PT, and theta score for the CA-PT were assessed. A linear model assessed the effect of the question mark score on theta, corrected for the conventional PT-score. Cluster analysis explored student subgroups per year. Results: Students with similar conventional PT scores who left more questions unanswered on the conventional PT generally performed better on CA-PT. This effect diminished as students advanced through their studies. Cluster analysis revealed a variable effect between different students, most pronounced in year 4, and a reverse effect in year 5. Discussion: Question mark option use significantly impacted student performance on PT, with a remarkable variability among students. This variability suggests that formula scoring captures more than knowledge alone, highlighting the need to align scoring methods with intended assessment goals.
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