Abstract Background: Competency-based medical education (CBME) introduced by the National Medical Commission emphasizes competency-oriented teaching and learning. Multiple-choice questions (MCQs) remain a key assessment tool, but their quality determines the validity and reliability of examinations. Item analysis using difficulty index, discrimination index (DI), and reliability helps in evaluating MCQs. This study was undertaken to assess the quality of MCQs used in Phase 2 MBBS internal examinations under the CBME curriculum. Materials and Methods: A prospective observational study was carried out on four internal assessments conducted during the 2024–2025 academic year for Phase 2 MBBS students. Each test contained 20 single-best-answer MCQs from microbiology. Item analysis was performed to calculate difficulty index, DI, and reliability (Cronbach’s alpha). Data were analyzed in SPSS version 26.0. Results: Out of 80 questions analyzed, 48 (60%) were within the acceptable difficulty range. Prefinal I showed a higher proportion of difficult items (25%), while prefinal II had the most easy items (25%). DI analysis revealed that prefinal I and II had the highest proportion of excellent discriminators (60%). Internal Assessment 1 and 2 also contained 30% poor discriminators. Reliability was consistently low across all tests, with Cronbach’s alpha values ranging from 0.365 to 0.586 (acceptable threshold ~ 0.7). Conclusion: The present study highlights the need for continuous review and refinement of MCQs, under CBME. Broader studies may help set reliable benchmarks for designing high-quality, competency-based medical assessments.
Nagasrilatha et al. (Sat,) studied this question.