Table 2.
Demographics, interventions, and outcome of the included studies
| Author, year | Country | Study design | Participants | Subject | Intervention | Co-intervention | MCQtype | MCQ Quality | Instrument | Findings |
|---|---|---|---|---|---|---|---|---|---|---|
| Palmer Eet al. 2006 [10] | Australia | RCT | 4th year N = 51 | Surgery | Students were split randomly into 2 groups, the first group had to write a case report while the second had to write 3 MCQs in addition to the case report. Students were guided to write good MCQs | NR | NR | 61% of MCQs: acceptable quality.Only 25% tested higher-order skills | Pre/post-test. | no significant difference |
| Survey (learning methods ranking) | Both groups ranked learning methods similarly | |||||||||
| Australia | Single group cross-sectional | 5th year N = 53 | Diverse | Students were asked to rank their preferred learning methods before and after an activity in which they had to do research on a topic witha presentation and construct 3 MCQs for their peers to answer | NR | NR | Students created good quality MCQs. | Survey | a significant difference for the MCQ as a learning exercise option (p = 0.04) but the ranking among other activities remains poor | |
| Chamberlain S et al. 2006 [43] | UK | Single-group cross-sectional | 1st year N = 3, 2nd year N = 3 |
Diverse | After item-writing training Students worked singly or with peers to create (MCQs).students were getting paid to write MCQs | Feedback on each option given. | Type A | NR | Qualitative feedback | Students reported that the method helped them to consolidate their knowledge and comprehension of the curriculum |
| Gooi ACet al., 2014 [46] | Canada | Single-cross-sectional | 1st year N = 113 | Oto-laryngology | First step: Introductory session to how to write a high quality MCQs. Second step: Self-study sessionLast step: students created MCQs.MCQs were reviewed by instructors | Studentsreviewed each other’s MCQs | Type A | NR | Survey | Creating MCQs valuable = 78%.Reviewing MCQs valuable = 79% Class-created MCQs is a valuable resource = 91%Interested in collaborating in future session = 86% |
| Grainger Ret al. 2018 [30] |
NewZealand | Singlegroup cross-sectional | 4th year N = 106 | Anatomic pathology | Students were instructed to write MCQs using bloom taxonomy and were required to write at least 2 in each module of anatomic pathology using PeerWise® | Rate and answer peer-generated MCQs, explain the answer and distractors. | Type A | 74% of the MCQs were tested high order skills | Survey. | Students that were not satisfied with the process = 81%. Only 37% of students believed that interaction with peers was useful |
| Shah MPet al. 2019 [25] |
USA | Single-group cross-sectional | 2nd year N = 11 | Cardio-pulmonary-renal | Students tooka workshop on how to write good quality MCQs and were asked to write MCQs on the lecture topics they were given | Giveexplanations of answers and distractors | NR | NR | Qualitative feedback | Studentsreported that creating MCQs and explaining answers helped them review key objectives and refined their test-taking strategies and would like to engage in similar activities |
| Walsh J et al. 2016 [44] |
UK | Cohort | Final year (5th) N = 20. | Diverse | Students were instructed to write and create a bank of MCQs, Questions produced were arranged into a series of tests. the performance of question writers was compared to the rest of the students | Students had to meet for peer and senior clinician review of their MCQs | Type A | NR | Post-test | Students who wrote and reviewed questions scored higher than average compared to the rest of the students at the end of year summative exam (p ≤ 0.001) |
| Kurtz JB et al. 2019 [38] |
USA | Single group cross-sectional | 2nd yearN = 18 | Cardiology | Participants were randomly divided into 6 groups of 3 students each, then students had to write 2 MCQs from exam blueprint subjects | Review MCQs with peers and faculty | Type A | NR | Qualitative analysis (n = 8). | Students found this activity beneficial on how to strategically approach MCQ examinations.Students voiced frustration about the time consumption |
| Open-ended survey (n = 10). | Students found the activity beneficial for their learning (mean = 3.9 ± 0.3), They did not agree or deny that this was an efficient method to review cardiology (mean = 2.9 ± 1.1) | |||||||||
| Benjamin HL et al. 2015 [47] |
UK | Single group cross-sectional | 5th year N = 20 | Diverse | Students were asked to volunteer to create an online MCQ database, students had to write MCQs in a standard format, then the senior clinician was asked to review and approve MCQs | Students checked and reviewed each other’s MCQs | Type A | High quality | Mixed method feedback | 100% positive feedback students reported question writing and/or peer review to be valuable for learning and useful for preparation and described it as enjoyable |
| Herrero JIet al. 2019 [26] |
Spain | RCT | 2nd & 3rd year N = 75 & N = 109 | General pathology & Physiopathology | Students were invited to write 4 MCQs on a topic that was randomly chosen. They were offered an extra 0.25 point if their questions were good enough. The best 2 questions on each topic were selected to be included in the exam | NR | NR | Poor quality | Post-test | Students performed significantly better when writing MCQs on certain modules compared to others |
| Rajendiren S et al. 2014 [27] |
India | Single-group Pre and post-test | First-year N = 135 | Biochemistry | Students were classified into three categories: high, medium, and low performers. They took a pre-test, then the 3 different groups were given MCQ stems of the same subject and were asked to create distractors and the right answer separately, then they were tested again | NR | Distractors and answer | Good quality | Pre and post-tests. | A significant difference between pre and post-tests in both high and low performers |
| Students feedback | 55% of students found the exercise to be challenging and must be used as a learning exercise | |||||||||
| Bobby Zet al. 2012 [48] |
India | Single-group Pre and post-test | First-year N = 84 | Biochemistry | Students took a pre-test then they were given 4 distractors in which one could be the answer. They were then asked to individually write the stem based on given keywords | Students engaged in small group discussions to review and modify MCQs of the group | Stems of MCQs | High quality | Pre and post-tests. | A significant difference between pre and the two post-tests in all students’ categories |
| Students Feedback | 95% of students wanted a second session in the future, 99% felt the exercise was not a burden | |||||||||
| Sircar SSet al. 1999 [52] |
India | Single-group cross-sectional | First-year N = 37 | Physiology | A contest in which students had to write MCQs was organized. the contributors of the best and highest number of MCQs would be awarded certificates. And the best MCQs would be included in exams | NR | assertion-reasons MCQs | NR | Students Feedback | Most students agreed the contest was useful to their learning, though some found it time-consuming |
| McLeod PJ & Snell L. 1996 [28] | Canada | Single-group cross-sectional | 2nd & 3rd year N = 150 | Diverse | Students were divided into 3 groups, each one spent in rotation a 10 weeks clinical course. Each one was expected to write two to five MCQs. All accepted student-generated questions were included in the summative exams | NR | 24% of MCQs were clinical case-based | Good quality | Students Feedback | Students appreciated how involved they were in the learning process. They recognized the benefits of reading when formulating a question |
| Papinczak T et al. 2012 [49] |
Australia | Cohort | 1st & 2nd year N = 384 | Diverse | In small groups, students were asked to devote at least 1 hour a week to write MCQs type assertion-reason.MCQs and answers were reviewed by one or 2 academics before being loaded to a questions bank | Students were also asked to write short-answer & complex patient-based questions | assertion-reasonMCQs | Good quality | Pre and post-test. | Slight drop in grades |
| Questionnaire | 26% of students found the activity time consuming and challenging than expected. 77.3% supported the continuation of the project. |
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| Stone MRet al. 2017 [31] |
USA | Single-group cross-sectional | 1st & 2nd year (N = 39). | Diverse | Students were asked to participate in crowd-sourced practice quizzes made of MCQs, matching, and true/false questions, based on the material taught. Each participant had to write questions for a certain number of lectures | Students took quizzes made of questions they generated | NR | Good quality | Post-test | No statistically significant difference between participants and non-participants. low performers benefited more from the process. Writing and taking tests were more effective than each one alone |
| Survey | 81.3% of students stated they felt more positive when they wrote MCQ | |||||||||
| Walsh JLet al. 2018 [29] |
UK | Cohort | 1st & 2nd year N = 603 | Diverse | PeerWise® was introduced to the first-year class of 2014. Over 2 years, students were asked to write MCQs. | Students were also asked to comment and rate their peers’ MCQs | NR | Acceptable quality |
Post-test | There were significant correlations between writing, answering, and commenting frequency with summative examination performance (p < 0.001, R = 0.24, 0.13, and 0.15, respectively). PeerWise® users performed significantly better than non-users (p < 0.001) |
| Students feedback | Students appreciated curricular specificity, and they were worried about the quality of student-authored questions | |||||||||
| Jobs A et al. 2013 [45] |
Germany | Single-group cross-sectional | 4th year N = 102 | Internal Medicine | Internal Medicine was divided into 4 sections which students had to take an exam on each. Students wrote MCQs 3 weeks before exams instructed by an approved manual, exam included some questions written by students | NR | Type A | Poor quality | Post-test | Low performers did significantly better while high performers didn’t have a measurable advantage |
| Questionnaire | students spent less time designing MCQs compared to other methods. No apparent beneficial effects on learning habits |
MCQs: Multiple-choice questions; N: Number; NR: Not reported; RCT: Randomized controlled trial