Detection of flawed multiple-choice questions in preclinical medical education using item difficulty and discrimination indices: a six-year analysis

While p- and/or r_pb-value thresholds detected 85.7% of flawed items, 14.3% were missed, underscoring that static thresholds are insufficient to ensure item quality. This study provides empirical evidence supporting the integration of quantitative indices with expert review in exam evaluation. Incorporating items where the keyed answer has a p-value less than or similar to distractors may improve detection but increase workload, reflecting a trade-off between accuracy and feasibility.