Excess Abbreviations in Multiple-Choice Questions Reduce Exam Validity

By Sean P. Kane, PharmD, BCPS

Published June 17, 2025

How Abbreviations Reduce Exam Validity

Excessive or unclear abbreviations force students to spend cognitive resources on decoding terminology rather than demonstrating their understanding of concepts. This is particularly problematic when abbreviations are non-standard, field-specific, or have multiple possible meanings that could confuse students even when they possess the relevant content knowledge.

In most cases, these abbreviations are not part of the learning objectives, are not specifically taught in class, and often have multiple meanings. As an example, the medical abbreviation "LFT" may mean "liver function test" or "lung function test" depending on the context. Similarly, non-standard abbreviations seen in medical charts, like "ssx" (signs/symptoms), "s/p" (status post), "r/o" (rule out), and "HLD" (hyperlipidemia), will often not be known to students who do not have a history of work experience in certain healthcare areas.

Cognitive Load Implications

Working memory research demonstrates that unfamiliar or ambiguous abbreviations create additional cognitive burden for test-takers. Students must simultaneously decode the abbreviation, access their knowledge about the concept it represents, and apply that knowledge to answer the question. This multi-step process can overwhelm cognitive capacity, particularly under testing conditions.

When students are uncertain about abbreviation meanings, they may experience increased anxiety and self-doubt that further impact their performance on subsequent questions, creating cascading effects throughout the assessment.

Types of Problematic Abbreviations

• Non-standard Abbreviations: Acronyms or shortened forms that aren't widely recognized in the field or that represent institutional-specific terminology rather than universal professional language.
• Multiple Meaning Abbreviations: Letters or shortened forms that could represent different concepts depending on context (e.g., "MS" could mean multiple sclerosis, mental status, or medical student).
• Unnecessary Shortening: Using abbreviated forms when the full term would be clearer and wouldn't significantly increase question length or complexity.
• Inconsistent Usage: Mixing abbreviated and full forms randomly throughout an assessment or using different abbreviations for the same concept.

Example of Excess Abbreviations Flaw in Health Sciences Education

Equity and Accessibility Concerns

Excessive abbreviations can create particular challenges for certain student populations:

• English Language Learners: May struggle with abbreviations even when they understand the underlying concepts, creating language barriers unrelated to content knowledge.
• Students from Different Educational Backgrounds: Those trained in different institutions or systems may be unfamiliar with specific abbreviation conventions.
• Students with Learning Differences: May have particular difficulty with abbreviated forms that require additional processing steps to decode.
• Non-traditional Students: Those entering fields from other careers may not have acquired familiarity with field-specific abbreviation patterns.

Standards for Appropriate Use

• Universal Recognition: Use only abbreviations that are universally recognized and standardized within the professional field being assessed.
• First Use Definition: When abbreviations must be used, provide the full term on first reference, followed by the abbreviation in parentheses.
• Consistency: Maintain consistent abbreviation usage throughout the entire assessment. If a term is abbreviated in one question, use the same abbreviation throughout.
• Necessity Test: Ask whether the abbreviation is necessary for the question or whether the full term would be clearer without significantly impacting question quality.

Best Practices for Using Abbreviations

While it is best to avoid abbreviations whenever possible, there are times when they are necessary or even desirable (e.g., when testing knowledge of common, standardized abbreviations). In such cases, follow these best practices:

• Define on First Use: If an abbreviation must be used, define it the first time it appears (e.g., "Computerized Tomography (CT)").
• Use Standardized Abbreviations Only: Stick to widely accepted, standardized abbreviations that are part of the learning objectives.
• Avoid Ambiguity: Never use an abbreviation that could have multiple meanings in the context of the exam.

Excessive or non-standard abbreviations in exam questions undermine assessment validity and leave students confused or unfairly disadvantaged. This not only increases anxiety but also shifts focus away from evaluating students' content mastery. ExamEval offers an AI-powered platform that automatically detects and eliminates problematic abbreviations, helping faculty create clear, equitable, and high-quality assessments.

References

1. Rudolph MJ, Daugherty KK, Ray ME, Shuford VP, Lebovitz L, DiVall MV. Best Practices Related to Examination Item Construction and Post-hoc Review. Am J Pharm Educ. 2019;83(7):7204. doi:10.5688/ajpe7204
2. Dell KA, Wantuch GA. How-to-guide for writing multiple choice questions for the pharmacy instructor. Curr Pharm Teach Learn. 2017;9(1):137-144. doi:10.1016/j.cptl.2016.08.036