Most standardized tests, such as the USMLE, PMHNP, PRITE, or ABPN, are in multiple choice question format. The difficulty of MCQ tests seem to vary across individuals. Some love them, some (most?) hate them. There’s a biological reason for this!
Have you noticed that taking a test based on multiple choice questions makes you think differently compared to taking a test based on essays? Multiple choice questions make your brain process information differently. Specifically, multiple choice questions rely on recognition, whereas essay and open ended questions rely on retrieval.
Recognition… plus a little more
When you’re presented with options to answer a question, your brain kicks into recognition mode. It will look for associated information it has seen before to bypass using retrieval (a process that takes more effort). While this is cut and dry, an interesting phenomena can occur in regard to the distractor answers, i.e., the incorrect answers.
You may disregard the incorrect answers because you recognize the correct option, but your brain tucks those incorrect options away. Later, when you are presented with a question related to those answers your brain can spontaneously retrieve those answers more easily because its seen them associated with questions before. Crazy, right? Even if the MCQ test primarily uses recognition, your brain MacGyvers it into a means of storing more information to use later!
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Little JL, Frickey EA, Fung AK. The role of retrieval in answering multiple-choice questions. J Exp Psychol Learn Mem Cogn. 2019 Aug;45(8):1473-1485. doi: 10.1037/xlm0000638. Epub 2018 Aug 16. PMID: 30113206.