Item analysis and performance of EMQ, MCQ, and SAQ in dental education and students’ perception of extended-matching questions

BACKGROUND: Although multiple-choice questions (MCQs), short-answer questions (SAQs), and extended-matching questions (EMQs) are widely used in dental education, simultaneous comparison of the psychometric properties of these formats in one single educational setting has been less investigated. Also, given the more complex structure of the EMQs, the role of students' perception in their approach and performance still needs further investigation. This study aimed to conduct an item analysis and compare student performance across EMQ, MCQ, and SAQ formats in dental education and to assess students' perception of extended-matching questions. METHODS: This cross-sectional analytical study was conducted on 29 senior dental students in 2025-2026. The end-of-semester exams of four selected courses included a total of 15 EMQs, 45 MCQs, and 30 SAQs, all of which were designed and standardized based on the Bloom's taxonomy levels. Perception of EMQs was assessed with a standard questionnaire with confirmed validity and reliability [content validity ratio (CVR) = 0.85, content validity index (CVI) = 0.82, Cronbach's alpha = 0.81] and a five-point Likert scale (range 15 to 75). Psychometric properties including difficulty, discrimination, and distractor efficiency (DE) of the answer choices were calculated. Data were analyzed by ANOVA, independent t, Mann-Whitney, repeated measures, and Pearson's correlation tests (α = 0.05). RESULTS: EMQs were significantly more difficult than MCQs and SAQs (P < 0.001). There was no difference in discrimination among the formats (P > 0.05), and DE was higher in MCQs (P = 0.014). Student performance differed significantly among the formats (P < 0.001), with students obtaining the highest mean scores in SAQs. The mean perception score of EMQs was 44.80 ± 6.92, which was within the average range. Perception did not differ by gender (P = 0.786) or grade point average (GPA) (P = 0.386), but it did differ among the courses (P < 0.001). No significant correlation was found between perception and performance in EMQs (P = 0.211). CONCLUSION: Structural differences in question formats affect student experience and performance, and the mean perception of EMQs is not necessarily related to performance. Appropriate use of formats and strengthening students' familiarity with EMQs can help improve the quality of assessment.