It’s exam season in the UK and it got me thinking back to my own experiences in the dreaded exam hall, finding my allotted place amid the row upon row of single desks and chairs. And then the nerve-wracking rush towards the end of the exam to finish all the questions in time. I can remember thinking, if only there were more questions that required only short answers.
Interestingly, in medical education, that idea has evolved into a serious assessment strategy.
Short Answer Questions (SAQs) and Very Short Answer Questions (VSAQs) are increasingly being recognised as effective alternatives to traditional multiple-choice formats in high-stakes medical exams. Studies* have shown that they can achieve high levels of reliability and discrimination while testing knowledge in a way that is often closer to real clinical practice.
Unlike Single Best Answer (SBA) questions, where candidates select from a list of possible responses, SAQs and VSAQs require learners to generate the answer themselves. That difference matters.
In clinical settings, doctors are not presented with five possible diagnoses and asked to pick one. They must recall information, interpret evidence, and arrive at conclusions independently. Very short answer formats more closely mimic this real-world cognitive process.
They can also reduce one of the persistent weaknesses of multiple-choice testing: cueing and guessing. Even well-designed SBA questions may allow candidates to infer the correct answer through elimination techniques or pattern recognition. VSAQs remove many of those cues, providing a clearer picture of what candidates genuinely know.
Deeper understanding and recall
This has implications not only for assessment quality, but also for learning behaviour. Assessment shapes study habits. When students know they must actively retrieve information rather than recognise it from a list, they are more likely to focus on deeper understanding and recall. In this way, very short answer formats may encourage more effective learning strategies while also revealing gaps in knowledge that might otherwise remain hidden.
Increased efficiency
Another advantage is efficiency. While essay-style answers can provide rich insight into reasoning, they are time-consuming to mark and difficult to standardise consistently at scale. VSAQs occupy an interesting middle ground: brief enough to support efficient marking—particularly with digital systems—while still requiring constructed responses from candidates.
Digital exam platforms are helping to make these formats increasingly practical in large-scale medical assessments. Sophisticated response matching, examiner review workflows, and analytics tools can support reliable delivery and marking, even across substantial candidate cohorts.
Of course, no single question type is perfect for every purpose. High-quality assessment usually depends on combining multiple approaches, each chosen to test different dimensions of competence. But the growing interest in short and very short answer questions reflects a broader shift in medical assessment: away from recognition alone, and towards demonstrating authentic understanding. For candidates, that may feel more demanding. For educators and institutions, it may provide a more accurate measure of readiness for clinical practice.
To discuss how digital systems can help you optimise your question creation and deployment send me a message, I’d love to chat.
*Amir H. Sam et al. (2018)“Very-short-answer questions: reliability, discrimination and acceptability” Published in Medical Education
Amir H. Sam et al. (2019)“Comparing single-best-answer and very-short-answer questions for assessing applied medical knowledge in 20 UK medical schools” Published in BMJ Open
van Wijk et al. (2023) “Use of very short answer questions compared to multiple choice questions in undergraduate medical students: An external validation study” Published in PLOS ONE
Potter & McLachlan (2025)“Assessing medical knowledge: A 3-year comparative study of very short answer vs. multiple choice questions” Published in Medical Teacher