Work

Effect of Fatigue and Item Order On Students’ Performance in Multiple-choice Based Examinations: A Progress Test-Based Study

Year: 2026

Type: article

Abstract: Introduction Test length may influence performance through position-related effects, particularly toward the end of an examination due to fatigue. In computer-based tests with fixed navigation, item position may contribute to differences in performance that are not fully attributable to differences in knowledge. Methods We investigated whether the performance of students from the 1st to the 6th undergraduate years on a 120-item multiple-choice Progress Test examination was influenced by item position and fatigue. The 120 items were first arranged in a randomized sequence across the different content areas. Once this sequence was established, it remained fixed, and the two groups completed it in opposite directions: Group 1 answered the items from 1 to 120, whereas Group 2 answered them from 120 to 1 and that this sequence. For comparisons between the groups, we used a pooled item-level analysis, calculating the proportion of correct answers for each item and its corresponding confidence interval. Subsequently, a random-effects proportional meta-analysis of the differences in item-level proportions was performed. Heterogeneity was assessed using the I² statistic. Results Students in Group 1 outperformed those in Group 2 on the first batch of items, whereas the opposite pattern was observed for the second batch. Differences in heterogeneity decreased from the 1st to the 6th undergraduate years, suggesting a more stable response pattern among senior students than among junior students. Conclusions Our findings suggest that fatigue may interfere with students’ performance on items presented toward the end of an examination. However, the effect was not strong enough to substantially affect overall scores. The different patterns observed across the 1st to 6th years suggest varying susceptibility to fatigue, indicating that fatigue may be an important consideration, particularly among less experienced students.

Source: Medical Science Educator

DOI: 10.1007/s40670-026-02883-5