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. 2016 Sep 29;16:250. doi: 10.1186/s12909-016-0773-3

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© The Author(s). 2016

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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Fig. 1 — Relationship between item complexity (cognitive level I-IV) and item difficulty (percent correct). As question complexity increased (cognitive level I-IV), the percentage of correct responses decreased. (Letters indicate statistical p < 0.028 differences among levels of item complexity)