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Background: Multiple Choice Tests (MCQs) are commonly used assessment tool in medical schools, which is delivered to our student in four versions (A, B, C and D) to avoid cheating. The aim of this study was to investigate the effect of scrambling test items on students’ performance and the difficulty level of each version, so as to decide on continuing randomization of test items or keeping it without randomization. Methods: A prospective, cross-sectional study was conducted, the participants were the 5th year undergraduate medical students during their major course of obstetrics and gynecology. Three tests where items were randomized are delivered to the students. After correction, the marks obtained by the candidates and difficulty index of each version were entered into the Statistical Package for Social Sciences (SPSS) version 20 and comparison amongst these four versions was carried out through analysis of variance (ANOVA). A p-value of <0.05 was considered as statistically significant. Results: No significant difference was found in the mean difficulty index for different versions in each test and there are no statistically different results when we compared version A mean students’ scores to other versions (B, C and D) after applying ANOVA analysis (F = 1.14, p = 0.42), (F = 0.75, p = 0.69) and (F = 1.29, p = 0.34); (F = 0.84, p = 0.62), (F = 0.81, p = 0.64) and (F = 0.62, p = 0.79); (F = 0.62, p = 0.79), (F = 0.35, p = 0.95) and (F = 0.83, p = 0.64) for test 1, 2 and 3 respectively. Conclusions: Our study revealed that randomization of MCQs test item into versions to avoid cheating does not affect student performance or the difficulty level of the exam.

The Effect of Scrambling Test Item on Students’ Performance and Difficulty Level of MCQs Test in a College of Medicine, KKU