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Comparison of cognitive workload between very short answer questions and multiple-choice questions

An eye-tracking experiment

Bibliographic Data

ID15328648
AuthorsMaria Gabriela Carneiro Queiroz (0009-0008-8964-0499, Universidade Estadual de Campinas (UNICAMP), corresponding author), Francisco Carlos Specian Junior (0000-0002-4220-2642, Universidade Estadual de Campinas (UNICAMP)), Pedro Tadao Hamamoto Filho (0000-0001-6436-9307, Departament of Neurosciences and Mental Health, Botucatu Medical School, Universidade Estadual Paulista (UNESP)), Thiago Martins Santos (0000-0002-3595-4088, Universidade Estadual de Campinas (UNICAMP)), Stefan K Schauber (0000-0002-1832-2732, University of Oslo), Andrea M Woltman (0000-0001-9904-6751, Institute of Medical Education Research Rotterdam (iMERR), Erasmus MC University Medical Centre Rotterdam), Dario Cecilio-Fernandes (0000-0002-8746-1680, Universidade Estadual de Campinas (UNICAMP))
Year2026
Volume31
Issue1
Pages2621434-2621434
Publication date2026-01-26
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueMedical Education Online (JOURNAL)
Journal identifiersISSN: 1087-2981 • E-ISSN: 1087-2981
PublisherTaylor & Francis (PUBLISHER • GB)
DOI10.1080/10872981.2026.2621434
PMID41588719
OpenAlexW7125800026
LanguageEN
References cited37

Very short answer questions (VSAQs) have gained attention for their superior psychometric properties compared to multiple-choice questions (MCQs). While VSAQs require knowledge recall, MCQs primarily involve knowledge recognition. This difference in cognitive processes may lead to varying cognitive workloads, defined as the amount of mental processing in working memory. Previous studies have not demonstrated consistent differences, likely due to reliance on self-reported measures. Eye tracking provides objective, process-level indicators of cognitive workload. This study investigated whether answering VSAQs requires a higher cognitive workload than answering MCQs. In a within-subject randomized crossover experiment, sixth-year medical students answered both VSAQs and MCQs. Cognitive workload was measured using screen-based eye tracking, focusing on the number of fixations and revisitations as objective indicators of mental effort. Data were analyzed using mixed-effects models. Thirty-four medical students participated, yielding 1,326 observations, which is the multiplication of the number of students by the number of questions (39 questions). Mixed-effects models showed a significant effect of question type on both workload indicators: VSAQs elicited more fixations and revisitations than MCQs (β_std = 0.30-0.39, p p < .01). Heatmaps confirmed these findings, showing denser fixations on key diagnostic features for VSAQs and on answer options for MCQs. Answering VSAQs imposed a higher cognitive workload than MCQs. The presence of answer options in MCQs may reduce workload by providing unintentional cues, while VSAQs require active retrieval. Eye tracking proved valuable for distinguishing cognitive workload across assessment formats

Cognition · Cognitive Load · Cognitive test · Eye movement · Eye tracking · Tracking (education · Workload · Clinical Reasoning and Diagnostic Skills · Educational Strategies and Epistemologies · Visual and Cognitive Learning Processes

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