Item statistics derived from three-option versions of multiple-choice questions are usually as robust as four- or five-option versions: implications for exam design.

Different versions of multiple-choice exams were administered to an undergraduate class in human physiology as part of normal testing in the classroom. The goal was to evaluate whether the number of options (possible answers) per question influenced the effectiveness of this assessment. Three exams (each with three versions) were given to each of two sections during an academic quarter. All versions were equally long, with 30 questions: 10 questions with 3 options, 10 questions with 4, and 10 questions with 5 (always one correct answer plus distractors). Each question appeared in all three versions of an exam, with a different number of options in each version (three, four, or five). Discrimination (point biserial and upper-lower discrimination indexes) and difficulty were evaluated for each question. There was a small increase in difficulty (a lower average score on a question) when more options were provided. The upper-lower discrimination index indicated a small improvement in assessment of student learning with more options, although the point biserial did not. The total length of a question (number of words) was associated with a small increase in discrimination and difficulty, independent of the number of options. Quantitative questions were more likely to show an increase in discrimination with more options than nonquantitative questions, but this effect was very small. Therefore, for these testing conditions, there appears to be little advantage in providing more than three options per multiple-choice question, and there are disadvantages, such as needing more time for an exam.