High time for a change: psychometric analysis of multiple-choice questions in nursing.

Nurse educators teach students to develop an informed nursing practice but can educators claim the same grounding in the available evidence when formulating multiple-choice assessment tools to evaluate student learning? Multiple-choice questions are a popular assessment format within nursing education. While widely accepted as a credible format to assess student knowledge across disciplines, debate exists among educators regarding the number of options necessary to adequately test cognitive reasoning and optimal discrimination between student abilities. The purpose of this quasi-experimental between groups study was to examine the psychometric properties of three option multiple-choice questions when compared to the more traditional four option questions. Data analysis revealed that there were no statistically significant differences in the item discrimination, difficulty or the mean examination scores when multiple-choice test questions were administered with three versus four option answer choices. This study provides additional guidance for nurse educators to assist in improving multiple-choice question writing and test design.