ExamEval
Item Writing Flaws
Complex Vocabulary

Complex Vocabulary: When Sesquipedalian Words Become Barriers on Multiple-Choice Assessments

By Sean P. Kane, PharmD, BCPS

Published June 19, 2025

How Complex Vocabulary Impedes Assessment

The inappropriate use of complex vocabulary in exam questions can transform assessments from measures of content knowledge into tests of linguistic sophistication. When questions employ unnecessarily complicated language, specialized terminology unrelated to the learning objectives, or culturally specific expressions, they create barriers that prevent students from demonstrating their actual understanding of the subject matter.

A properly designed assessment should be a tool to measure a student's understanding of the course content. If knowledge of complex or uncommonly used words is not a component of the learning objectives of the course but is required to answer a question correctly, the question is flawed and not a reliable measure of a student's knowledge.

Critical Issue

Complex vocabulary introduces construct-irrelevant variance, meaning the assessment measures something other than the intended content knowledge. In this case, it measures vocabulary and reading comprehension skills, which may not be part of the learning objectives. This can unfairly disadvantage students with lower linguistic proficiency, including non-native speakers.

The Vocabulary Barrier Problem

Complex vocabulary becomes problematic when it is used for sophistication rather than precision, when it is unrelated to the actual content being assessed, or when it creates unnecessary cognitive load that interferes with students' ability to access and apply their knowledge. For example, using a term like "sesquipedalian" in a medical exam question about pharmacology serves no purpose other than to test vocabulary. As Diaz-Gilbert (2004) notes, this is a significant barrier for pharmacy students for whom English is not their first language, as it can prevent them from demonstrating their content mastery.

Students may possess complete understanding of the concepts being tested but struggle to demonstrate this knowledge because they are unable to decode unnecessarily complex language. This situation is particularly unfair because it penalizes students for linguistic factors rather than content mastery.

Types of Problematic Vocabulary

Unnecessarily Complex Synonyms: Using sophisticated words when simpler alternatives would convey the same meaning more clearly (e.g., "utilize" instead of "use," "demonstrate" instead of "show").
Discipline-Irrelevant Complexity: Employing complex vocabulary from other fields when it's not essential to the content being assessed (e.g., using complex literary terms in a science question).
Cultural or Regional Terms: Including vocabulary that may be unfamiliar to students from different cultural or geographic backgrounds, even when this vocabulary isn't related to the learning objectives (e.g., referring to "paracetamol" instead of "acetaminophen" without clarification in a US-based exam).
Archaic or Overly Formal Language: Using outdated or excessively formal expressions that don't reflect contemporary professional communication (e.g., stating "the patient was in possession of a febrile condition" instead of "the patient had a fever").

Example of Complex Vocabulary Flaw in Health Sciences Education

Flawed Question

A geriatric patient manifesting protracted emesis subsequent to a cholecystectomy necessitates meticulous evaluation for potential electrolyte derangements. Which electrolyte abnormality is of paramount concern in this clinical scenario?

A. Hypokalemia ✓

B. Hypernatremia

C. Hypocalcemia

D. Hypermagnesemia

The flawed question uses unnecessarily complex vocabulary (e.g., "manifesting protracted emesis", "subsequent to", "necessitates meticulous evaluation", "electrolyte derangements", "paramount concern") that obscures the core clinical concept being tested.

Corrected Question

An elderly patient who has been vomiting for a long time after gallbladder surgery needs careful checking for electrolyte imbalances. Which electrolyte problem is the most important to check for in this situation?

A. Low potassium (hypokalemia) ✓

B. High sodium (hypernatremia)

C. Low calcium (hypocalcemia)

D. High magnesium (hypermagnesemia)

The corrected question uses simpler, more direct language while still assessing the same clinical knowledge. It also clarifies the options by providing both the common term and the medical term (e.g., "Low potassium (hypokalemia)"), although these clarifications could be omitted if the intent is to assess students' understanding of these medical terms.

Equity and Access Implications

Complex vocabulary disproportionately affects certain student populations:

English Language Learners: May understand the concepts but struggle with sophisticated vocabulary, particularly idiomatic expressions or culturally specific terms.
First-Generation College Students: May not have been exposed to academic vocabulary conventions that other students take for granted.
Students from Diverse Socioeconomic Backgrounds: May have had different vocabulary exposure that does not reflect their intellectual capacity or content knowledge.

Examples of Unnecessarily Complex Vocabulary in Health Sciences Exams

The following non-medical terms are commonly used in multiple choice assessment questions but may be confusing to certain students:

Administer ("give")
Alleviate ("relieve")
Ascertain ("find out")
Cease ("stop")
Facilitate ("help")
Inquire ("ask")
Mitigate ("reduce")
Utilize ("use")

A 2004 study by Diaz-Gilbert found that these commonly used medical terms may not be fully understood by English as a second language (ESL) students and are unlikely to be part of a course's learning objectives:

Confide ("share privately")
Drowsy ("sleepy")
Exacerbate ("worsen")
Exertion ("effort")
Groggy ("sleepy" or "confused")
Lethargic ("weak", "tired", or "no energy")
Perky ("energetic")
Persist ("continue")

Solutions for Clear Communication

Use Precise, Professional Language: Choose words that convey meaning accurately without unnecessary complexity. Professional terminology should be included when it's essential for practice, but avoid decorative sophistication.
Define Technical Terms When Necessary: When specialized vocabulary is required for the assessment, provide clear definitions or context clues to ensure all students can access the content.
Maintain Content-Relevant Vocabulary: Be cognizant of including technical terms only if knowledge of these terms directly relates to a learning objective (e.g., do not define "hyponatremia" if students are expected to understand this term).
Write for Your Audience: Consider the language level appropriate for students at their current stage of professional development. Advanced students can handle more technical language, but it should still be clear and purposeful.

Want to ensure your exam questions are free from unnecessary linguistic complexity? ExamEval uses expert AI to automatically detect and flag complex or confusing vocabulary, helping educators create clearer, more equitable assessments that truly measure student knowledge.

References

Haladyna TM, Downing SM, Rodriguez MC. A review of multiple-choice item-writing guidelines for classroom assessment. Appl Meas Educ. 2002;15(3):309-334. doi:10.1207/S15324818AME1503_5
Diaz-Gilbert M. Vocabulary knowledge of pharmacy students whose first or best language is not English. Am J Pharm Educ. 2004;68(4) Article 91.