Using randomization to compare AI and expert-generated formative assessment questions in medical education

BACKGROUND: AI-generated content is being used across the education spectrum and is beneficial for creating complex multiple-choice questions, such as those used in medical education. However, evaluating AI-generated content is challenging, and existing testing and evaluation methods are falling short. This study uses randomization to compare medical students' performance on and subjective evaluation of AI versus expert-generated questions. We hypothesized that there would be no difference in student performance or subjective evaluation of AI vs expert-generated questions. METHODS: We designed a single-center, randomized study where medical student participants received either one AI- or expert-generated question per day over four weeks. The cumulative proportion of questions answered correctly over 28 days was consistent across the two question sets. However, participants rated 53% of AI-generated questions as very easy or easy compared with only 31% of the expert-generated questions. DISCUSSION: Randomization was crucial to show that AI-generated questions were nearly imperceptible from expert-generated questions, demonstrating the need for additional evaluation methods to compare AI- and expert-generated medical education content.