# Use of Multiple-Choice Items in Summative Examinations: Questionnaire Survey Among German Undergraduate Dental Training Programs

## TL;DR

This study surveyed German dental schools to understand how they use multiple-choice exams, finding significant variation in question types and scoring methods.

## Contribution

The study provides the first comprehensive survey on multiple-choice item usage in German dental summative exams.

## Key findings

- All German dental schools use multiple-choice exams for summative assessments.
- Single-choice Type A items are most common, while multiple-select items show significant variation in scoring.
- Only half of the schools have a formal item review process.

## Abstract

Multiple-choice examinations are frequently used in German dental schools. However, details regarding the used item types and applied scoring methods are lacking.

This study aims to gain insight into the current use of multiple-choice items (ie, questions) in summative examinations in German undergraduate dental training programs.

A paper-based 10-item questionnaire regarding the used assessment methods, multiple-choice item types, and applied scoring methods was designed. The pilot-tested questionnaire was mailed to the deans of studies and to the heads of the Department of Operative/Restorative Dentistry at all 30 dental schools in Germany in February 2023. Statistical analysis was performed using the Fisher exact test (P<.05).

The response rate amounted to 90% (27/30 dental schools). All respondent dental schools used multiple-choice examinations for summative assessments. Examinations were delivered electronically by 70% (19/27) of the dental schools. Almost all dental schools used single-choice Type A items (24/27, 89%), which accounted for the largest number of items in approximately half of the dental schools (13/27, 48%). Further item types (eg, conventional multiple-select items, Multiple-True-False, and Pick-N) were only used by fewer dental schools (≤67%, up to 18 out of 27 dental schools). For the multiple-select item types, the applied scoring methods varied considerably (ie, awarding [intermediate] partial credit and requirements for partial credit). Dental schools with the possibility of electronic examinations used multiple-select items slightly more often (14/19, 74% vs 4/8, 50%). However, this difference was statistically not significant (P=.38). Dental schools used items either individually or as key feature problems consisting of a clinical case scenario followed by a number of items focusing on critical treatment steps (15/27, 56%). Not a single school used alternative testing methods (eg, answer-until-correct). A formal item review process was established at about half of the dental schools (15/27, 56%).

Summative assessment methods among German dental schools vary widely. Especially, a large variability regarding the use and scoring of multiple-select multiple-choice items was found.