ArticleMedical education online2026
Generating multiple-choice questions using reverse engineering techniques.
Article in Medical education online, 2026. 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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Authors and funding
5 authors.
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Abstract
The study is aimed at exploring the potential of using ChatGPT-4 to develop multiple-choice questions that adhere to item development principles through the application of reverse engineering techniques in nursing education. To determine whether ChatGPT-4 could generate multiple-choice questions regarding medical-surgical nursing, the researchers first evaluated ChatGPT-4's level of nursing knowledge. The researchers then developed 20 prompts using reverse engineering techniques; these were subsequently entered into ChatGPT-4, resulting in the generation of 60 multiple-choice questions. All 60 questions were reviewed by five nursing education experts to evaluate compliance with item development principles. ChatGPT-4 demonstrated a high accuracy rate (98.00%) when answering multiple-choice questions about medical-surgical nursing education. AI-generated questions primarily adhered to the principles of item development, with an average compliance score of 7.90/9.00. The least adhered to among the nine-question development principles was 'The question stem should use only essential words or phrases.' Given that the AI-generated questions may serve as preliminary drafts for use in nursing education following expert review, ChatGPT-4 can function as a valuable tool in the design of educational materials. When utilizing ChatGPT-4, it is beneficial for nursing educators to apply reverse engineering techniques that enhance question quality through repeated comparison, as well as to analyze the prompts and corresponding AI-generated questions. Furthermore, including structured outlines and representative sample multiple-choice questions using Markdown syntax in the prompt can enhance the quality of AI-generated questions.
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