Abstract
INTRODUCTION: Grade inflation in higher education poses challenges to maintaining academic standards, particularly in pharmacy education, where assessing student competency is crucial. This study investigates the impact of AI-generated multiple-choice questions (MCQs) on exam difficulty and reliability in a pharmacy management course at a Saudi university. METHODS: A quasi-experimental design compared the 2024 midterm exam, featuring ChatGPT-generated MCQs, with the 2023 exam that utilized human-generated questions. Both exams covered identical topics. Exam reliability was assessed using the Kuder-Richardson Formula 20 (KR-20), while difficulty and discrimination indices were analyzed. Statistical tests, including t-tests and chi-square tests, were conducted to compare performance metrics. RESULTS: The 2024 exam demonstrated higher reliability (KR-20 = 0.83) compared to the 2023 exam (KR-20 = 0.78). The 2024 exam included a greater proportion of moderate questions (30%) and one difficult question (3.3%), whereas the 2023 exam had 93.3% easy questions. The mean student score was significantly lower in 2024 (17.75 vs. 21.53, p < 0.001), and the discrimination index improved (0.35 vs. 0.25, p = 0.007), indicating enhanced differentiation between students. DISCUSSION: The findings suggest that AI-generated MCQs contribute to improved exam rigor and a potential reduction in grade inflation. However, careful review of AI-generated content remains essential to ensure alignment with course objectives and accuracy. CONCLUSION: AI tools like ChatGPT offer promising opportunities to enhance assessment integrity and support fairer evaluations in pharmacy education.