Purpose
Student summative assessments in professional schools are conducted predominantly through multiple-choice question (MCQ) examinations. Poorly written questions - where diction or syntax distracts students from demonstrating their understanding and application of knowledge - may negatively impact performance. This study aims to explore the barriers that students face when answering MCQs, the test-taking strategies they employ to overcome these barriers, and their views on fairness in assessments.

Methods
A total of 32 first-year dental students and graduate students in the Master of Medical Science (MAMS) program at Boston University Chobanian & Avedisian School of Medicine completed a 20-question simulated physiology assessment and demographic survey. Focus groups were conducted to explore strategies for approaching MCQs. An inductive thematic analysis was conducted to identify themes emerging from the data.

Results
Participants identified their level of understanding, difficulty accessing language, time constraints, and resource accessibility as barriers impacting their ability to correctly answer MCQs. On the other hand, test-taking strategies, self-awareness, access to practice questions, and well-constructed items without flaws were helpful in selecting the correct answer choice. Fairness in assessment was characterized as having equal resource accessibility, improving language accessibility, eliminating item flaws, reducing cognitive load, and testing key concepts across different cognitive levels.

Conclusion
These findings provide insight into how item flaws may affect a test-taker’s ability to answer MCQs accurately. The identified barriers may disproportionately affect students from underrepresented groups. Faculty should review their questions for the presence of flaws, eliminate unnecessary linguistic complexity, and provide practice questions to minimize barriers in assessment design. Assessments play an important role in decision-making processes and can influence students’ career trajectories. Ensuring equitable assessments may contribute to diversifying the healthcare workforce and fostering culturally competent care for our diverse population.