Nonfunctional distractor analysis: An indicator for quality of Multiple choice questions

OBJECTIVES: To analyze the low to medium distractor efficiency items in a multiple-choice question (MCQ) paper for item writing flaws. METHODS: This qualitative study was conducted at Islamic International Medical College Rawalpindi, in October 2019. Archived item- analysis report from a midyear medium stakes MCQ paper of 2(nd) year MBBS class, was analyzed to determine the non-functional distractors (NFDs) and distractor efficiency (DE) of items, in a total of 181 MCQs. DE was categorized as low (3-4 NFDs), medium (1-2 NFDs) and high (0 NFD). Subsequently, qualitative document analysis of the MCQ paper whose item analysis report was assessed was conducted to investigate the item flaws in the low to medium DE items. The flaws identified were coded and grouped as, within option flaws, alignment flaws between options and stem/ lead-in and other flaws. RESULTS: Distractor efficiency was high in 69 items (38%), moderate in 75 items (42%) and low in 37 items (20%). The item-writing flaws identified in low to moderate DE items within distractors included, non-homogenous length (1.8%), non-homogenous content (8%) and repeat in distractor (1.7%). Alignment flaws between distractors and stem/ lead-in identified were linguistic cues (10%), logic cues (12.5%) and irrelevant distractors (16%). Flaws unrelated to distractors were low cognitive level items (40%) and unnecessarily complicated stems (11.6%). CONCLUSIONS: Analyzing the low to medium DE items for item writing flaws, provides valuable information about item writing errors which negatively impact the distractor efficiency.