WONG Lik Wei1,*, Embang Johan Emilio GONZALES2, and Ira Agrawal1
1Department of Physiology, Yong Loo Lin School of Medicine (YLLSOM), National University of Singapore (NUS)
2Alice Lee Centre for Nursing Studies, YLLSOM, NUS
Sub-Theme
Building Learning Relationships
Keywords
Co-creation, collaborative, motivation, self-determination theory, multiple-choice questions
Category
Lightning Talks
Introduction
Writing-to-learn assignments applying the concepts of higher-order thinking improve subsequent examination performance (Nevid et al., 2017). The educational benefits of engaging students in the creation of question development from course content themselves have been deemed successful regarding learning outcomes (Bates 2014). One method of engaging students in the course material has been the production of multiple-choice questions (MCQs) development. This approach is closely linked to the concept of retrieval practice that enhances and solidifies learning by encouraging the recall of facts and concepts. This practice also significantly boosts long-term retention and overall learning (Karpicke & Blunt, 2011).
Rationale of Study
We believe that involving students in the teaching and learning process fosters the co-construction of knowledge and enhances their motivation to learn. Such involvement not only increases learners’ sense of engagement, ownership, and empowerment, but also provides valuable feedback for improving the tools we use or develop for their classes. This study explores how collaborative MCQ creation influences student motivation, engagement, and academic performance, while also examining students’ perceptions of the learning experience.
Methods
Seventy-six second-year undergraduate students enrolled in PHS2101 Physiology for Pharmaceutical Sciences participated in this study, which focused on the nervous and musculoskeletal systems contributing to Continuous Assessment II (CA2). Students were organised into 13 groups of 5–6 members and encouraged to submit at least one MCQ per lecture, each with four answer choices and an explanation of the correct answer. Submitted questions were reviewed by an instructor and uploaded to Canvas for peer practice. These quizzes were ungraded. Student performance in CA2 was analysed in relation to the number of MCQs created and answered. The cognitive level of student-generated MCQs was categorised using Bloom’s Taxonomy. Motivation and engagement were assessed using the Self-Determination Theory (SDT) framework and the Intrinsic Motivation Inventory (IMI) via a post-module survey.
Key Findings
Of the 76 students, 64 (from 11 groups) created and submitted at least one MCQ. The average CA2 scores were similar between students who created MCQs (37.37) and those who did not (37.71). However, students who created MCQs showed slightly greater improvement from their CA1 scores (6.84% vs. 6.42%). Students who created questions for both systems (n=28) demonstrated the greatest improvement (7.77%). Those who both created and answered MCQs (n=23) achieved the highest average CA2 scores (38.02). Analysis of the students’ generated MCQs showed that 68.6% were at the “Remember” or “Understand” levels, while 31.4% reached the “Apply” or “Analyze” levels. The overall need satisfaction score was 3.39 ± 0.77, with autonomy rated highest (3.41 ± 0.73), followed by competence (3.41 ± 0.88) and relatedness (3.39 ± 0.77). IMI results indicated positive responses, particularly in perceived value/usefulness (3.85 ± 0.76) and interest/enjoyment (3.21 ± 0.73) related to creating MCQs. Answering peer-generated MCQs was rated even higher in value/interest (4.40 ± 0.66). Qualitative responses revealed that creating MCQs supported deeper understanding, content reinforcement, self-assessment, and higher-order thinking. Answering MCQs helped identify misconceptions, clarify concepts, and improve exam readiness. Suggestions for improvement included enhanced structure, clearer guidance, better alignment with exams, and increased practice opportunities.
Significance of the Study
Collaborative MCQ creation and answering are complementary active learning strategies that enhance conceptual understanding, motivation, and metacognitive skills. MCQ creation encourages higher-order thinking, synthesis, and conceptual ownership because it is generative in nature, as students construct knowledge by designing questions. In contrast, MCQ answering promotes reflection, self-assessment, and efficient validation of learning because it is evaluative in nature, as students test and confirm what they know. Both contribute to conceptual clarity through different cognitive routes. Together, these practices promote autonomous, engaged, and deep learning in health education.
References
Bates, S. P., et al. (2014). Assessing the quality of a student-generated question repository. Physical Review Special Topics-Physics Education Research, 10(2), 020105.
Karpicke, J. D. & Blunt J. R. (2011) Retrieval practice produces more learning than elaborative studying with concept mapping. Science, 331(6018), 772-775.
Nevid, J.S., Ambrose, M.A. & Pyun, Y.S. (2017) Effects of higher and lower level writing-to-learn assignments on higher and lower level examination questions. Teaching of Psychology, 44(4), 324-329.