Item Analysis: The impact of distractor efficiency on the discrimination power of multiple choice items

Item Analysis: The impact of distractor efficiency on the discrimination power of multiple choice items | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Item Analysis: The impact of distractor efficiency on the discrimination power of multiple choice items Assad Ali Rezigalla, Elwathiq Khalid Ibrahim, Amar Babiker ElHussein This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.2.15899/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Distractor efficiency of multiple choice item responses is a component of item analysis used by the examiners to to evaluate the credibility and functionality of the distractors.Objective To evaluate the impact of functionality (efficiency) of the distractors on difficulty and discrimination indices.Methods A cross-sectional study in which standard item analysis of an 80-item test consisted of A type MCQs was performed. Correlation and significance of variance among Difficulty index (DIF), discrimination index (DI), and distractor Efficiency (DE) were measured. Results There is a significant moderate positive correlation between difficulty index and distractor efficiency, which means there is a tendency for high difficulty index go with high distractor efficiency (and vice versa). A weak positive correlation between distractor efficiency and discrimination index. Conclusions Non-functional distractor can reduce discrimination power of multiple choice questions. More training and effort for construction of plausible options of MCQ items is essential for the validity and reliability of the tests. Internal Medicine item analysis Distractor efficiency difficulty index discrimination index correlation introduction Well-constructed multiple-choice questions (MCQs) are appropriate tools for the assessment of the cognitive learning domain. It can test a wide range of knowledge, including; recalling, comprehension, and problem-solving, with high objectivity and accurate interpretation of content validity ( 1 ). The effectiveness of MCQs in assessing the learning of the students can be measured both by pre-validation and post-validation methods. Item analysis is a statistical process which is used as a post-validation method for measuring the effectiveness of MCQs regarding their validity and reliability ( 2 ). Item analysis is a mathematical analysis of students’ responses on an exam (test) to evaluate the quality items and consequently improving the assessment ( 3 ). The main advantage of item analysis is the ability to increase the effectiveness of the exam. The effectiveness of the exam is improved either by refining the defected items or deletion of poorly constructed ones from the questions bank ( 3 , 4 ). Item analysis includes three components; difficulty index (DIF), discrimination index (DI), and distractor Efficiency (DE) ( 5 , 6 ). The distractor Efficiency (DE) is a component of item analysis that allows the assessor to evaluate the credibility of incorrect options (distractors) of MCQ item. The distractor is considered functioning (FD) if selected by not less than 5% of the group of the examinee ( 7 ). Distractors efficiency (DE) is calculated according to the number of non-functional distractors per item (NFD) ( 8 ). This study was conducted to evaluate the impact of non-functional distractors (NFD) on the difficulty and discrimination indices of the test items. Materials and Methods Study design This is a cross-sectional, analytic study. It was conducted at the University of Bisha, College of Medicine (UBCOM) in the duration from April to June 2018. UBCOM adopts a three-phase, integrated approach to undergraduate medical curriculum. Material One of the phase I modules exams, the Principles of Human Diseases was selected for the study. This is an integrated, multi-disciplinary module which is conducted during the second semester of year two (number of the students was 45). The test was consisted of 59 items of multiple choice questions (type A MCQs). Each item is formed of a stem followed by four options, a single best answer, and three distractors. No penalty for the blank or wrong answers. The exam blueprint was developed by the course instructors and reviewed by A standing Students Assessment Committee ( 9 ). Following the exam, standard item analysis was obtained (Apperson, Data Link 1200) and processed for the study. To calculate the distractors efficiency, the items were classified according to the number of non-functional distractors into; poor (3NFD), moderate (2NFD), good (1NFD) and excellent (0NFD) ( 3 , 8 , 10 , 11 ). Ethical consideration The study was approved by UBCOM research and ethics committee. Statistical analyses The data obtained from the standard item analysis were analyzed by using SPSS V20 (Armonk, NY: IBM Corp, USA). Descriptive statistics and Pearson correlation coefficient were applied to measure the significance of difference and correlation among different variables. Level of significance was fixed at 95%, and any P < 0.05 was considered to be significant. results Item analysis: The total number of items analyzed was 59. The average score of the class was 55.5 (69.38%). Class median was 56.0 (70.0%). Highest and lowest scores were 78 (97.50%) and 35 (43.75%) respectively. KR-20 was 0.906. The average DIF and DIS of the test were 69.4 (±21.86) and 0.3 (±0.16), respectively (Table 1). Items were classified according to DE, DIS, and DIF table 2, 3, and 4, respectively. There is a significant moderate positive correlation between DIF and DE, which means there is a tendency for high DIF go with high DE (and vice versa). A weak positive correlation between DE and Disc Index (Table 5). Mean Median Minimum Maximum Standard Deviation DIF 37.5 35.48 3.23 87.10 19.046446 DISC 0.46 0.5 0 0.88 0.22972616 Table 1: The descriptive statistics of exam items. Distractor efficiency (DE) Frequency Percent Poor (3NFD) 25 2 3.4 Moderate (2NFD) 50 13 22.0 Good (1NFD) 75 22 37.3 Excellent (0NFD)100 22 37.3 Total 59 100.0 Table 2: The distractor efficiency of exam items. Classification of exam items according to the number of nonfunctional distractors (NFD). Discrimination index Frequency Percent Cannot discriminate 2 3.4 Acceptable 6 10.2 Good 10 16.9 Excellent 41 69.5 Total 59 100.0 Table 3: The discrimination index of exam items. Classification of exam items according to the discrimination index of exam items. difficulty index of the exam (DIF) Frequency Percent Easy 2 3.4 Difficult 14 23.7 Acceptable 43 72.9 Total 59 100.0 Table 4: The difficulty index of exam items. Classification of exam items according to the difficulty index of exam items. Correlations DE DIF DIS DE Pearson Correlation 1 .538** .259* Sig. (2-tailed) .000 .047 N 59 59 59 **. Correlation is significant at the 0.01 level (2-tailed). *. Correlation is significant at the 0.05 level (2-tailed). Table 5: The correlation between DE, DIF, and Disc. discussion The number of exam items was adjusted according to the course blueprint and the tested domains. The KR-20 examination was 0.906, ideal, and showing high reliability of the standard examination ( 12 , 13 ). Values such as 0.8 and higher are the aims of medical education. This finding is in agreement with the work of Kehoe ( 12-14 ). He reported that for short tests (10-15 items) values of as low as 0.5 are reasonable, but those tests with more than 50 items should yield values of 0.8 or higher. Low values of KR-20 were linked to many easy or difficult questions, poorly written nondiscriminating items, non-homogeneity of educational contents, and the discrepancy between the assessment level and the educational task( 14 , 15 ). The both of majority of exam items (72.9%) and the average exam difficulty (69.4±21.86) were within the acceptable difficulty index range. Moreover, 69.5% of the items were categorized as excellent discriminating, and the average exam discrimination index was 0.3 (±0.16). The type of correlation between DE and DIF indicates that items with less non-functional distractors have high difficulty index (easy items) and vice versa. This finding in agreement with recent works of Hingorjo et al., Burud et al. and Kheyami et al. ( 8 , 16 , 17 ). The decreased number of non-functional distractor increases the difficulty index of items (become easier). Also, they reported that the DE reduces the DIS of items. In the current study, DE has a weak positive correlation with the DIS (P=0.047437, is significant at p < .05). NFDs can affect the discrimination power of the item ( 8 ) and should be replaced by more plausible distractors ( 11 ) or the item removed from the test ( 18 ). Such items have high DIF ( 8 ) as all students well got them right 23( 11 )or become distracting and causing a false assessment ( 10 ). NFDs were linked to minimal training of items writing and distractors selection ( 7 , 19 , 20 ). It is clear that DE has an impact on both DIF and DIS individually, but whether it can affect both of them at the same time, need more research work. Items with nonfunctional distractors can be present in any exam or test; the second step after defining them in the running exam remains open. In such items, the nonfunctional distractors can be changed with more plausible ones or deletion of the question from the bank. The area of debate is the status of these items in the current exam or test. In the current study deletion of items with two or three non-functional distractors increased the average difficulty index of the exam to from 36.83 to 42.82 and DE showed non-significant correlation with DIF of items (r= 0.2296, p= 0.133806). Deletion of such items from exam or test can affect students results and raises ethical debate. Kehoe (1995) reported that deletion of such items is ethical and justifiable ( 14 ). He argued that the test aims to determine the rank of each student. Using items or questions with unacceptable psychometrics is against this objective, and the accuracy of the resulting ranking is degraded. Limitations of this study include the fewer number of students and items and application on one course. The strength of the study, the test is considered valid and reliable. conclusions Non-functional distractor can reduce discrimination power of multiple choice question. More training and effort for construction of plausible options of MCQ items is essential for the validity and relaibilty of the tests. abbreviations DE: Distractor Efficiency DIF: Difficulty Index DI: Discrimination Index UBCOM: University of Bisha, College of Medicine declarations Confilct of Interest: None of the authors has a financial or professional benefit that affect the scientific judgement of the study. Funding: The study received no funding Availability of Data: The dataset which is used and analyzed to derive the results of this article are available and ready to be provided by the corresponding author on reasonable request. Consent for Publication: Not applicable Ethical Approval: The study was approved by the Research and Ethics committee of theUniversity of Bisha, College of Medicine. Authors Participation: All authors made substantial contributions to the conception and design of the study and to the analysis of the data. RAA did the data collection and entry and drafted the literature and methodology section of the article. IEK revised the article and added the discussion and conclusion section. EAB performed data analysis and reporting. Acknowledgements: The authors wish to express their acknowlegent to Dr. Ali el-eragi, Associate Professor of Microbiology for providing the rough data (the exm papers, blueprint and item analysis documents). references Sahoo DP, Singh R. Item and distracter analysis of multiple choice questions (MCQs) from a preliminary examination of undergraduate medical students. International Journal of Research in Medical Sciences. 2017;5(12):5351. Rao C, Prasad HK, Sajitha K, Permi H, Shetty J. Item analysis of multiple choice questions: Assessing an assessment tool in medical students. International Journal of Educational and Psychological Researches. 2016;2(4):201. Abdulghani HM, Ahmad F, Ponnamperuma GG, Khalil MS, Aldrees A. The relationship between non-functioning distractors and item difficulty of multiple choice questions: a descriptive analysis. Journal of Health Specialties. 2014;2(4):148. Considine J, Botti M, Thomas S. Design, format, validity and reliability of multiple choice questions for use in nursing research and education. Collegian. 2005;12(1):19-24. Mahjabeen W, Alam S, Hassan U, Zafar T, Butt R, Konain S, et al. Difficulty Index, Discrimination Index and Distractor Efficiency in Multiple Choice Questions. Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University. 2018;13(4):310-5. Tavakol M, Dennick R. Post-examination analysis of objective tests. Medical Teacher. 2011;33(6):447-58. Tarrant M, Ware J, Mohammed AM. An assessment of functioning and non-functioning distractors in multiple-choice questions: a descriptive analysis. BMC medical education. 2009;9:40. Hingorjo MR, Jaleel F. Analysis of one-best MCQs: the difficulty index, discrimination index and distractor efficiency. JPMA-Journal of the Pakistan Medical Association. 2012;62(2):142. Abdellatif H, Al-Shahrani AM. Effect of blueprinting methods on test difficulty, discrimination, and reliability indices: cross-sectional study in an integrated learning program. Advances in medical education and practice. 2019;10:23. Gajjar S, Sharma R, Kumar P, Rana M. Item and test analysis to identify quality multiple choice questions (MCQS) from an assessment of medical students of Ahmedabad, Gujarat. Indian journal of community medicine: official publication of Indian Association of Preventive & Social Medicine. 2014;39(1):17. Tarrant M, Ware J, Mohammed AM. An assessment of functioning and non-functioning distractors in multiple-choice questions: a descriptive analysis. BMC Medical Education. 2009;9(1):1. Bland JM, Altman DG. Statistics notes: Cronbach's alpha. Bmj. 1997;314(7080):572. Carmines EG, Zeller RA. Reliability and validity assessment: Sage publications; 1979. Kehoe J. Basic item analysis for multiple-choice tests. Practical assessment, research & evaluation. 1995;4(10):20-4. van de Watering G, van der Rijt J. Teachers’ and students’ perceptions of assessments: A review and a study into the ability and accuracy of estimating the difficulty levels of assessment items. Educational Research Review. 2006;1(2):133-47. Burud I, Nagandla K, Agarwal P. Impact of distractors in item analysis of multiple choice questions. International Journal of Research in Medical Sciences. 2019;7(4):1136. Kheyami D, Jaradat A, Al-Shibani T, Ali FA. Item Analysis of Multiple Choice Questions at the Department of Paediatrics, Arabian Gulf University, Manama, Bahrain. Sultan Qaboos University Medical Journal. 2018;18(1):e68. Haladyna TM, Downing SM. Validity of a taxonomy of multiple-choice item-writing rules. Applied Measurement in Education. 1989;2(1):51-78. Schuwirth LW, Van Der Vleuten CP. Different written assessment methods: what can be said about their strengths and weaknesses? Medical education. 2004;38(9):974-9. Crehan KD, Haladyna TM, Brewer BW. Use of an inclusive option and the optimal number of options for multiple-choice items. Educational and Psychological Measurement. 1993;53(1):241-7. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6556","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":180378,"identity":"8a163c7f-9eea-46ee-b8be-4aab7b589673","order_by":1,"name":"Assad Ali Rezigalla","email":"","orcid":"","institution":"University of Bisha","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Assad","middleName":"Ali","lastName":"Rezigalla","suffix":""},{"id":180379,"identity":"f846dd30-2d7b-4469-8b90-c731cba7b98b","order_by":2,"name":"Elwathiq Khalid Ibrahim","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIie3NsQqCQBzH8b8ItZy4XoP5ChcuQkOvYjS0VGPQEkJwLoGrjyEI0uhxqzXf6BNEEURL0L+gLTrbGu4Lf7nBDz8Ak+kf6+JZMQUXCL46bYiNJ5D04h8JAKvaEtcmg8t5F3qFmldwWkrwk+o76W1IQEVNg1ItIis7SGB19J0w6eRUcDou1YzZDkcCGjKSTnF7kiJDckfip41mxXbK10pOkVhIQGlWqHSv4Z7TIKuPkdgepoQpzYqb8Ila8bWXJnPR3JbDvp9qVt5ZMX4qPNLu/zcxmUwm08cewrFGY8R8Qj0AAAAASUVORK5CYII=","orcid":"","institution":"University of Bisha","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Elwathiq","middleName":"Khalid","lastName":"Ibrahim","suffix":""},{"id":180380,"identity":"8d5ea788-f5ad-4e75-9450-2b273bc2dd22","order_by":3,"name":"Amar Babiker ElHussein","email":"","orcid":"","institution":"Medicine Program, Nile College, Khartoum, Sudan","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Amar","middleName":"Babiker","lastName":"ElHussein","suffix":""}],"badges":[],"createdAt":"2019-10-05 13:30:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.2.15899/v1","doiUrl":"https://doi.org/10.21203/rs.2.15899/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13475517,"identity":"9b8761aa-d89c-4e82-a862-39b57fe7abb9","added_by":"auto","created_at":"2021-09-16 21:25:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":266549,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6556/v1/54e5a65d-23f0-4780-882a-f333c688c563.pdf"}],"financialInterests":"","formattedTitle":"Item Analysis: The impact of distractor efficiency on the discrimination power of multiple choice items","fulltext":[{"header":"introduction ","content":"\n\u003cp\u003eWell-constructed multiple-choice questions (MCQs) are appropriate tools for the assessment of the cognitive learning domain. It can test a wide range of knowledge, including; recalling, comprehension, and problem-solving, with high objectivity and accurate interpretation of content validity (\u003ca href=\"#_ENREF_1\"\u003e1\u003c/a\u003e).\u003c/p\u003e\n\u003cp\u003eThe effectiveness of MCQs in assessing the learning of the students can be measured both by pre-validation and post-validation methods. Item analysis is a statistical process which is used as a post-validation method for measuring the effectiveness of MCQs regarding their validity and reliability (\u003ca href=\"#_ENREF_2\"\u003e2\u003c/a\u003e). Item analysis is a mathematical analysis of students’ responses on an exam (test) to evaluate the quality items and consequently improving the assessment (\u003ca href=\"#_ENREF_3\"\u003e3\u003c/a\u003e). The main advantage of item analysis is the ability to increase the effectiveness of the exam. The effectiveness of the exam is improved either by refining the defected items or deletion of poorly constructed ones from the questions bank (\u003ca href=\"#_ENREF_3\"\u003e3\u003c/a\u003e, \u003ca href=\"#_ENREF_4\"\u003e4\u003c/a\u003e). Item analysis includes three components; difficulty index (DIF), discrimination index (DI), and distractor Efficiency (DE) (\u003ca href=\"#_ENREF_5\"\u003e5\u003c/a\u003e, \u003ca href=\"#_ENREF_6\"\u003e6\u003c/a\u003e). The distractor Efficiency (DE) is a component of item analysis that allows the assessor to evaluate the credibility of incorrect options (distractors) of MCQ item. The distractor is considered functioning (FD) if selected by not less than 5% of the group of the examinee (\u003ca href=\"#_ENREF_7\"\u003e7\u003c/a\u003e). Distractors efficiency (DE) is calculated according to the number of non-functional distractors per item (NFD) (\u003ca href=\"#_ENREF_8\"\u003e8\u003c/a\u003e).\u003c/p\u003e\n\u003ch3\u003eThis study was conducted to evaluate the impact of non-functional distractors (NFD) on the difficulty and discrimination indices of the test items.\u003c/h3\u003e"},{"header":"Materials and Methods","content":"\n\u003ch2\u003eStudy design\u003c/h2\u003e\n\u003cp\u003eThis is a cross-sectional, analytic study. It was conducted at the University of Bisha, College of Medicine (UBCOM) in the duration from April to June 2018. UBCOM adopts a three-phase, integrated approach to undergraduate medical curriculum.\u003c/p\u003e\n\u003ch2\u003eMaterial\u003c/h2\u003e\n\u003cp\u003eOne of the phase I modules exams, the Principles of Human Diseases was selected for the study. This is an integrated, multi-disciplinary module which is conducted during the second semester of year two (number of the students was 45).\u003c/p\u003e\n\u003cp\u003eThe test was consisted of 59 items of multiple choice questions (type A MCQs). Each item is formed of a stem followed by four options, a single best answer, and three distractors. No penalty for the blank or wrong answers.\u003c/p\u003e\n\u003cp\u003eThe exam blueprint was developed by the course instructors and reviewed by A standing Students Assessment Committee (\u003ca href=\"#_ENREF_9\"\u003e9\u003c/a\u003e). Following the exam, standard item analysis was obtained (Apperson, Data Link 1200) and processed for the study.\u003c/p\u003e\n\u003cp\u003eTo calculate the distractors efficiency, the items were classified according to the number of non-functional distractors into; poor (3NFD), moderate (2NFD), good (1NFD) and excellent (0NFD) (\u003ca href=\"#_ENREF_3\"\u003e3\u003c/a\u003e, \u003ca href=\"#_ENREF_8\"\u003e8\u003c/a\u003e, \u003ca href=\"#_ENREF_10\"\u003e10\u003c/a\u003e, \u003ca href=\"#_ENREF_11\"\u003e11\u003c/a\u003e).\u003c/p\u003e\n\u003ch2\u003eEthical consideration\u003c/h2\u003e\n\u003ch3\u003eThe study was approved by UBCOM research and ethics committee.\u003c/h3\u003e\n\u003ch2\u003eStatistical analyses\u003c/h2\u003e\n\u003cp\u003eThe data obtained from the standard item analysis were analyzed by using SPSS V20 (Armonk, NY: IBM Corp, USA). Descriptive statistics and Pearson correlation coefficient were applied to measure the significance of difference and correlation among different variables. Level of significance was fixed at 95%, and any\u003cem\u003e P \u003c/em\u003e\u0026lt; 0.05 was considered to be significant.\u003c/p\u003e"},{"header":"results","content":"\u003cp\u003e\u003cstrong\u003eItem analysis:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe total number of items analyzed was 59. The average score of the class was 55.5 (69.38%). Class median was 56.0 (70.0%). Highest and lowest scores were 78 (97.50%) and 35 (43.75%) respectively. KR-20 was 0.906. The average DIF and DIS of the test were 69.4 (\u0026plusmn;21.86) and 0.3 (\u0026plusmn;0.16), respectively (Table 1).\u003c/p\u003e\n\u003cp\u003eItems were classified according to DE, DIS, and DIF table 2, 3, and 4, respectively.\u003c/p\u003e\n\u003cp\u003eThere is a significant moderate positive correlation between DIF and DE, which means there is a tendency for high DIF go with high DE (and vice versa). A weak positive correlation between DE and Disc Index\u003c/p\u003e\n\u003cp\u003e(Table 5).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable width=\"528\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003eMean\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"60\"\u003e\n\u003cp\u003eMedian\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003eMinimum\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003eMaximum\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003eStandard Deviation\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003eDIF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e37.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"60\"\u003e\n\u003cp\u003e35.48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e3.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e87.10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003e19.046446\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003eDISC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"52\"\u003e\n\u003cp\u003e0.46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"60\"\u003e\n\u003cp\u003e0.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.88\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003e0.22972616\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 1: The descriptive statistics of exam items.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"159\"\u003e\n\u003cp\u003eDistractor efficiency (DE)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003eFrequency\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003ePercent\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"159\"\u003e\n\u003cp\u003ePoor (3NFD) 25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e3.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"159\"\u003e\n\u003cp\u003eModerate (2NFD) 50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e22.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"159\"\u003e\n\u003cp\u003eGood (1NFD) 75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e37.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"159\"\u003e\n\u003cp\u003eExcellent (0NFD)100\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e37.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"159\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"77\"\u003e\n\u003cp\u003e59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e100.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2: The distractor efficiency of exam items. Classification of exam items according to the number of nonfunctional distractors (NFD).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable width=\"278\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"134\"\u003e\n\u003cp\u003eDiscrimination index\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003eFrequency\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003ePercent\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"134\"\u003e\n\u003cp\u003eCannot discriminate\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e3.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"134\"\u003e\n\u003cp\u003eAcceptable\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e10.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"134\"\u003e\n\u003cp\u003eGood\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e16.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"134\"\u003e\n\u003cp\u003eExcellent\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e69.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"134\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e100.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3: The discrimination index of exam items. Classification of exam items according to the discrimination index of exam items.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable width=\"340\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"197\"\u003e\n\u003cp\u003edifficulty index of the exam (DIF)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003eFrequency\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003ePercent\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"197\"\u003e\n\u003cp\u003eEasy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e3.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"197\"\u003e\n\u003cp\u003eDifficult\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e23.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"197\"\u003e\n\u003cp\u003eAcceptable\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e72.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"197\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e100.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4: The difficulty index of exam items. Classification of exam items according to the difficulty index of exam items.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\" width=\"386\"\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelations\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"181\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eDE\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eDIF\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003eDIS\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"49\"\u003e\n\u003cp\u003eDE\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003ePearson Correlation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e.538**\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e.259*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003eSig. (2-tailed)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e.000\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e.047\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"133\"\u003e\n\u003cp\u003eN\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e59\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"68\"\u003e\n\u003cp\u003e59\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\" width=\"386\"\u003e\n\u003cp\u003e**. Correlation is significant at the 0.01 level (2-tailed).\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\" width=\"386\"\u003e\n\u003cp\u003e*. Correlation is significant at the 0.05 level (2-tailed).\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 5: The correlation between DE, DIF, and Disc.\u003c/p\u003e"},{"header":"discussion","content":"\u003cp\u003eThe number of exam items was adjusted according to the course blueprint and the tested domains.\u003c/p\u003e\n\u003cp\u003eThe KR-20 examination was 0.906, ideal, and showing high reliability of the standard examination (\u003ca href=\"#_ENREF_12\"\u003e12\u003c/a\u003e, \u003ca href=\"#_ENREF_13\"\u003e13\u003c/a\u003e). Values such as 0.8 and higher are the aims of medical education. This finding is in agreement with the work of Kehoe\u0026nbsp; (\u003ca href=\"#_ENREF_12\"\u003e12-14\u003c/a\u003e). He reported that for short tests (10-15 items) values of as low as 0.5 are reasonable, but those tests with more than 50 items should yield values of 0.8 or higher. Low values of KR-20 were linked to many easy or difficult questions, poorly written nondiscriminating items, non-homogeneity of educational contents, and the\u0026nbsp;discrepancy\u0026nbsp;between\u0026nbsp;the\u0026nbsp;assessment\u0026nbsp;level\u0026nbsp;and\u0026nbsp;the\u0026nbsp;educational\u0026nbsp;task(\u003ca href=\"#_ENREF_14\"\u003e14\u003c/a\u003e, \u003ca href=\"#_ENREF_15\"\u003e15\u003c/a\u003e).\u003c/p\u003e\n\u003cp\u003eThe both of majority of exam items (72.9%) and the average exam difficulty (69.4\u0026plusmn;21.86) were within the acceptable difficulty index range.\u0026nbsp; Moreover, 69.5% of the items were categorized as excellent discriminating, and the average exam discrimination index was 0.3 (\u0026plusmn;0.16).\u003c/p\u003e\n\u003cp\u003eThe type of correlation between DE and DIF indicates that items with less non-functional distractors have high difficulty index (easy items) and vice versa. This finding in agreement with recent works of Hingorjo et al., Burud et al. and Kheyami et al. (\u003ca href=\"#_ENREF_8\"\u003e8\u003c/a\u003e, \u003ca href=\"#_ENREF_16\"\u003e16\u003c/a\u003e, \u003ca href=\"#_ENREF_17\"\u003e17\u003c/a\u003e). The decreased number of non-functional distractor increases the difficulty index of items (become easier). Also, they reported that the DE reduces the DIS of items. In the current study, DE has a weak positive correlation with the DIS (P=0.047437, is significant at p \u0026lt; .05).\u0026nbsp; NFDs can affect the discrimination power of the item (\u003ca href=\"#_ENREF_8\"\u003e8\u003c/a\u003e) and should be replaced by more plausible distractors (\u003ca href=\"#_ENREF_11\"\u003e11\u003c/a\u003e) or the item removed from the test (\u003ca href=\"#_ENREF_18\"\u003e18\u003c/a\u003e). Such items have high DIF (\u003ca href=\"#_ENREF_8\"\u003e8\u003c/a\u003e) as all students well got them right 23(\u003ca href=\"#_ENREF_11\"\u003e11\u003c/a\u003e)or become distracting and causing a false assessment (\u003ca href=\"#_ENREF_10\"\u003e10\u003c/a\u003e).\u003c/p\u003e\n\u003cp\u003eNFDs were linked to minimal training of items writing and distractors selection (\u003ca href=\"#_ENREF_7\"\u003e7\u003c/a\u003e, \u003ca href=\"#_ENREF_19\"\u003e19\u003c/a\u003e, \u003ca href=\"#_ENREF_20\"\u003e20\u003c/a\u003e). It is clear that DE has an impact on both DIF and DIS individually, but whether it can affect both of them at the same time, need more research work. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eItems with nonfunctional distractors can be present in any exam or test; the second step after defining them in the running exam remains open.\u0026nbsp; In such items, the nonfunctional distractors can be changed with more plausible ones or deletion of the question from the bank.\u0026nbsp; The area of debate is the status of these items in the current exam or test.\u0026nbsp; In the current study deletion of items with two or three non-functional distractors increased the average difficulty index of the exam to from 36.83 to 42.82 and DE showed non-significant correlation with DIF of items (r= 0.2296, p= 0.133806). Deletion of such items from exam or test can affect students results and raises ethical debate.\u0026nbsp; Kehoe (1995) reported that deletion of such items is ethical and justifiable (\u003ca href=\"#_ENREF_14\"\u003e14\u003c/a\u003e). He argued that the\u0026nbsp;test aims\u0026nbsp;to\u0026nbsp;determine\u0026nbsp;the\u0026nbsp;rank\u0026nbsp;of\u0026nbsp;each\u0026nbsp;student.\u0026nbsp;Using items or questions with unacceptable psychometrics is against this objective, and the accuracy of the resulting ranking is degraded.\u003c/p\u003e\n\u003cp\u003eLimitations of this study include the fewer number of students and items and application on one course. The strength of the study, the test is considered valid and reliable.\u003c/p\u003e"},{"header":"conclusions ","content":"\u003cp\u003eNon-functional distractor can reduce discrimination power of multiple choice question. More training and effort for construction of plausible options of MCQ items is essential for the validity and relaibilty of the tests.\u003c/p\u003e"},{"header":"abbreviations ","content":"\u003cp\u003eDE: Distractor Efficiency\u003c/p\u003e\n\u003cp\u003eDIF: Difficulty Index\u003c/p\u003e\n\u003cp\u003eDI: Discrimination Index\u003c/p\u003e\n\u003cp\u003eUBCOM: University of Bisha, College of Medicine\u003c/p\u003e"},{"header":"declarations ","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConfilct of Interest:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; None of the authors has a financial or professional benefit that affect the scientific judgement of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received no funding\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of Data:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset which is used and analyzed to derive the results of this article are available and ready to be provided by the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for Publication:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthical Approval:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Research and Ethics committee of theUniversity of Bisha, College of Medicine.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors Participation:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors made substantial contributions to the conception and design of the study and to the analysis of the data. RAA did the data collection and entry and drafted the literature and methodology section of the article. IEK revised the article and added the discussion and conclusion section. EAB performed data analysis and reporting.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements:\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The authors wish to express their acknowlegent to Dr. Ali el-eragi, Associate Professor of Microbiology for providing the rough data (the exm papers, blueprint and item analysis documents).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"references","content":"\u003col\u003e\n\u003cli\u003eSahoo DP, Singh R. Item and distracter analysis of multiple choice questions (MCQs) from a preliminary examination of undergraduate medical students. International Journal of Research in Medical Sciences. 2017;5(12):5351.\u003c/li\u003e\n\u003cli\u003eRao C, Prasad HK, Sajitha K, Permi H, Shetty J. Item analysis of multiple choice questions: Assessing an assessment tool in medical students. International Journal of Educational and Psychological Researches. 2016;2(4):201.\u003c/li\u003e\n\u003cli\u003eAbdulghani HM, Ahmad F, Ponnamperuma GG, Khalil MS, Aldrees A. The relationship between non-functioning distractors and item difficulty of multiple choice questions: a descriptive analysis. Journal of Health Specialties. 2014;2(4):148.\u003c/li\u003e\n\u003cli\u003eConsidine J, Botti M, Thomas S. Design, format, validity and reliability of multiple choice questions for use in nursing research and education. Collegian. 2005;12(1):19-24.\u003c/li\u003e\n\u003cli\u003eMahjabeen W, Alam S, Hassan U, Zafar T, Butt R, Konain S, et al. Difficulty Index, Discrimination Index and Distractor Efficiency in Multiple Choice Questions. Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University. 2018;13(4):310-5.\u003c/li\u003e\n\u003cli\u003eTavakol M, Dennick R. Post-examination analysis of objective tests. Medical Teacher. 2011;33(6):447-58.\u003c/li\u003e\n\u003cli\u003eTarrant M, Ware J, Mohammed AM. An assessment of functioning and non-functioning distractors in multiple-choice questions: a descriptive analysis. BMC medical education. 2009;9:40.\u003c/li\u003e\n\u003cli\u003eHingorjo MR, Jaleel F. Analysis of one-best MCQs: the difficulty index, discrimination index and distractor efficiency. JPMA-Journal of the Pakistan Medical Association. 2012;62(2):142.\u003c/li\u003e\n\u003cli\u003eAbdellatif H, Al-Shahrani AM. Effect of blueprinting methods on test difficulty, discrimination, and reliability indices: cross-sectional study in an integrated learning program. Advances in medical education and practice. 2019;10:23.\u003c/li\u003e\n\u003cli\u003eGajjar S, Sharma R, Kumar P, Rana M. Item and test analysis to identify quality multiple choice questions (MCQS) from an assessment of medical students of Ahmedabad, Gujarat. Indian journal of community medicine: official publication of Indian Association of Preventive \u0026amp; Social Medicine. 2014;39(1):17.\u003c/li\u003e\n\u003cli\u003eTarrant M, Ware J, Mohammed AM. An assessment of functioning and non-functioning distractors in multiple-choice questions: a descriptive analysis. BMC Medical Education. 2009;9(1):1.\u003c/li\u003e\n\u003cli\u003eBland JM, Altman DG. Statistics notes: Cronbach's alpha. Bmj. 1997;314(7080):572.\u003c/li\u003e\n\u003cli\u003eCarmines EG, Zeller RA. Reliability and validity assessment: Sage publications; 1979.\u003c/li\u003e\n\u003cli\u003eKehoe J. Basic item analysis for multiple-choice tests. Practical assessment, research \u0026amp; evaluation. 1995;4(10):20-4.\u003c/li\u003e\n\u003cli\u003evan de Watering G, van der Rijt J. Teachers\u0026rsquo; and students\u0026rsquo; perceptions of assessments: A review and a study into the ability and accuracy of estimating the difficulty levels of assessment items. Educational Research Review. 2006;1(2):133-47.\u003c/li\u003e\n\u003cli\u003eBurud I, Nagandla K, Agarwal P. Impact of distractors in item analysis of multiple choice questions. International Journal of Research in Medical Sciences. 2019;7(4):1136.\u003c/li\u003e\n\u003cli\u003eKheyami D, Jaradat A, Al-Shibani T, Ali FA. Item Analysis of Multiple Choice Questions at the Department of Paediatrics, Arabian Gulf University, Manama, Bahrain. Sultan Qaboos University Medical Journal. 2018;18(1):e68.\u003c/li\u003e\n\u003cli\u003eHaladyna TM, Downing SM. Validity of a taxonomy of multiple-choice item-writing rules. Applied Measurement in Education. 1989;2(1):51-78.\u003c/li\u003e\n\u003cli\u003eSchuwirth LW, Van Der Vleuten CP. Different written assessment methods: what can be said about their strengths and weaknesses? Medical education. 2004;38(9):974-9.\u003c/li\u003e\n\u003cli\u003eCrehan KD, Haladyna TM, Brewer BW. Use of an inclusive option and the optimal number of options for multiple-choice items. Educational and Psychological Measurement. 1993;53(1):241-7.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"item analysis, Distractor efficiency, difficulty index, discrimination index, correlation","lastPublishedDoi":"10.21203/rs.2.15899/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.2.15899/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground Distractor efficiency of multiple choice item responses is a component of item analysis used by the examiners to to evaluate the credibility and functionality of the distractors.Objective To evaluate the impact of functionality (efficiency) of the distractors on difficulty and discrimination indices.Methods A cross-sectional study in which standard item analysis of an 80-item test consisted of A type MCQs was performed. Correlation and significance of variance among Difficulty index (DIF), discrimination index (DI), and distractor Efficiency (DE) were measured.\u003c/p\u003e\u003cp\u003eResults There is a significant moderate positive correlation between difficulty index and distractor\u0026nbsp;efficiency, which means there is a tendency for high difficulty index go with high distractor efficiency (and vice versa). A weak positive correlation between distractor efficiency and discrimination index.\u003c/p\u003e\u003cp\u003eConclusions Non-functional distractor can reduce discrimination power of multiple choice questions. More training and effort for construction of plausible options of MCQ items is essential for the validity and reliability\u0026nbsp;of the tests.\u003c/p\u003e","manuscriptTitle":"Item Analysis: The impact of distractor efficiency on the discrimination power of multiple choice items","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2019-10-10 01:45:27","doi":"10.21203/rs.2.15899/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9fb4d425-97e9-4541-89db-453c094f7324","owner":[],"postedDate":"October 10th, 2019","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":30857,"name":"Internal Medicine"}],"tags":[],"updatedAt":"","versionOfRecord":[],"versionCreatedAt":"2019-10-10 01:45:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6556","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"identity":"rs-6556","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}