Nonfunctioning Distractor Analysis for an Undergraduate Surgery Course Multiple-Choice Question Examination: A Descriptive Study

Abstract

Writing high-quality multiple-choice questions (MCQs) can be used to assess a wide range of clinical knowledge among medical students. Identifying and reviewing nonfunctioning distractors is crucial for improving the quality of the assessment. To evaluate the quality of the MCQs by reviewing the nonfunctioning distractor flaws. This is a descriptive study of the MCQ examination paper for the sixth-stage final course in surgery (2025), consisting of 100 MCQs with five options each (500 options). The distractor efficiency was calculated manually. Each question containing nonfunctioning distractors (<4%) is reviewed by specialized faculty to identify the types of flaws. A total of 400 distractors from 100 MCQs were reviewed, and 120 nonfunctioning distractors were identified (30%). Among these 120 items, 35 (29.2%) were low, 27 (22.5%) were medium, and 58 (48.3%) were high. The most common flaws were collectively exhaustive options (34 items, 28.3%); most of them were high. The convergence was 24 items (20%); most of them were high. Reviewing flaws in nonfunctioning distractors is a valuable tool for improvement in MCQ quality. The identified nonfunctioning distractors were comparable with those of other similar studies. Collectively exhaustive options and convergence are the most frequent flaws noticed.