A Novel Hybrid Multiple‐Choice Assessment Incorporating Constructed Responses: A Comparative Pilot Study of Dental Students' Perceptions

OBJECTIVES: To evaluate dental students' perceptions of a novel Hybrid Augmented Multiple-Choice Question (A-MCQ) format incorporating constructed responses, and to compare these perceptions with those of students assessed using a traditional MCQ format in fixed prosthodontics. METHODS: A comparative cross-sectional pilot study was conducted among fourth-year dental students (n = 154) at the only accredited Faculty of Dental Medicine in Tunisia. Two cohorts were assessed using either a Hybrid A-MCQ format (n = 77) or a traditional multiple-choice question (MCQ) format using the Smart Exam scoring approach (n = 77), which refers to the digital platform used for the administration and management of the traditional multiple-choice question (MCQ) examinations. The system enables computerised delivery of assessment items and automated score processing. Perceptions were collected using a 10-item Likert-scale questionnaire assessing clarity, understanding, higher-order thinking, clinical reasoning, engagement, confidence, satisfaction, and future use. Between-group comparisons were performed using the Mann-Whitney U test, with effect sizes calculated (r). RESULTS: Students assessed with traditional MCQs reported more positive perceptions across most domains, including clarity, understanding, confidence, satisfaction, and future use (p < 0.05). No differences were found for higher-order thinking or clinical reasoning. In the Hybrid A-MCQ group, perceptions were mixed, with limited agreement on its value for clinical reasoning and integration into assessment. CONCLUSIONS: Students perceived the Hybrid A-MCQ less positively than traditional MCQs and reported no advantage in higher-order thinking or clinical reasoning. The format was also associated with lower acceptability. These findings suggest a gap between assessment design and student experience, indicating the need for clear guidance, familiarisation, and alignment with learning outcomes. Further longitudinal studies with objective measures are required to evaluate its educational value.