Abstract The purpose of this study was to evaluate whether multiple-choice item difficulty could be predicted either by a subjective judgment by the question author or by applying a learning taxonomy to the items. Eight physiology faculty members teaching an upper-level undergraduate human physiology course consented to participate in the study. The faculty members annotated questions before exams with the descriptors “easy,” “moderate,” or “hard” and classified them according to whether they tested knowledge, comprehension, or application. Overall analysis showed a statistically significant, but relatively low, correlation between the intended item difficulty and actual student scores (ρ = −0.19, P < 0.01), indicating that, as intended item difficulty increased, the resulting student scores on items tended to decrease. Although this expected inverse relationship was detected, faculty members were correct only 48% of the time when estimating difficulty. There was also significant individual variation among faculty members in the ability to predict item difficulty (χ 2 = 16.84, P = 0.02). With regard to the cognitive level of items, no significant correlation was found between the item cognitive level and either actual student scores (ρ = −0.09, P = 0.14) or item discrimination (ρ = 0.05, P = 0.42). Despite the inability of faculty members to accurately predict item difficulty, the examinations were of high quality, as evidenced by reliability coefficients (Cronbach's α) of 0.70–0.92, the rejection of only 4 of 300 items in the postexamination review, and a mean item discrimination (point biserial) of 0.37. In conclusion, the effort of assigning annotations describing intended difficulty and cognitive levels to multiple-choice items is of doubtful value in terms of controlling examination difficulty. However, we also report that the process of annotating questions may enhance examination validity and can reveal aspects of the hidden curriculum. Bloom's taxonomy assessment evaluation multiple-choice questions standard setting physiology education medical education hidden curriculum Copyright © 2011 The American Physiological Society « Previous | Next Article » Table of Contents This Article doi: 10.​1152/​advan.​00062.​2011 Adv Physiol Educ December 2011 vol. 35 no. 4 396-401 » Abstract Free Full Text Free Full Text (PDF) Free Classifications How We Teach Services Email this article to a friend Alert me when this article is cited Alert me if a correction is posted Alert me when eletters are published Similar articles in this journal Similar articles in Web of Science Download to citation manager Responses Submit a response No responses published Citing Articles Load citing article information Citing articles via Web of Science Google Scholar Articles by Kibble, J. D. Articles by Johnson, T. PubMed Articles by Kibble, J. D. Articles by Johnson, T. Related Content Load related web page information Current Issue December 2011, 35 (4) Alert me to new issues of Adv Physiol Educ About the Journal Information for Authors Submit a Manuscript Ethical Policies AuthorChoice PubMed Central Policy Reprints and Permissions Advertising Press Copyright © 2011 the American Physiological Society Print ISSN: 1043-4046 Online ISSN: 1522-1229 var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www."); document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E")); var pageTracker = _gat._getTracker("UA-2924550-1"); pageTracker._trackPageview();

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