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Open-ended items were easier, yet more discriminative. MCQs with higher number of options were easier. Open-ended questions were significantly more discriminative in comparison to MCQs as case based items while they were more discriminative as noncase based items. Conclusion Item formats, structure, and number of options in MCQs significantly affected the psychometric properties of the studied items. Noncase based items and open-ended items were easier and more discriminative than case based items and MCQs, respectively. Examination item
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