The impact of ethnicity information in single best answer questions on student performance, item response time and psychometric properties
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Inclusion of patient age and sex in single best answer (SBA) questions is standard practice, whereas ethnicity is typically included only when considered clinically relevant. This selective use may inadvertently cue students or introduce bias. This study examined whether including patient ethnicity in SBA questions influences student performance, response time and item psychometric properties. A prospective randomised controlled study was conducted using two versions of a final-year formative assessment. In each version, approximately half of the questions included the patient’s ethnicity, while the corresponding questions in the alternate version omitted this information. Students were randomly assigned to one of the two exam versions. Two hundred and sixty-seven final-year medical students participated in the study. The mean score for questions without ethnicity was 80.3% and for questions with ethnicity was 79.8% (mean difference = −0.5 pp, p = 0.12). On average, students spent 1.6 seconds longer to answer questions with ethnicity compared to questions without ethnicity (p < 0.01). In SBA questions with and without ethnicity, there was no significant difference in mean facility (79.8% vs. 80.3%, p = 0.17) or mean item–total score point-biserial correlation (0.20 vs. 0.21, p = 0.63). These indicate that including patient ethnicity did not significantly impact overall student performance or mean item-level psychometric properties. However, it was associated with longer response times, suggesting a small but significant increase in cognitive load. Educators involved in assessment design should carefully consider this added cognitive burden when deciding whether to include patient ethnicity in future assessments.
Date Issued
2025-12-05
Date Acceptance
2025-11-02
Citation
Advances in Health Sciences Education, 2025
ISSN
1382-4996
Publisher
Springer
Journal / Book Title
Advances in Health Sciences Education
Copyright Statement
© The Author(s) 2025 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/41348285
PII: 10.1007/s10459-025-10489-6
Subjects
Assessment
DIVERSITY
Education & Educational Research
Education, Scientific Disciplines
Ethnicity
Health Care Sciences & Services
Life Sciences & Biomedicine
MEDICAL-EDUCATION
Race
Science & Technology
Single best answer questions
Social Sciences
TIPS
Undergraduate medical education
Publication Status
Published online
Coverage Spatial
Netherlands
Date Publish Online
2025-12-05