AI vs Human Exam Assessment and Development (AHEAD Trial)

The Artificial Intelligence (AI) vs Human Exam Assessment and Development (AHEAD) Trial is a participant-blinded randomized controlled trial conducted among first-year medical students at the University of British Columbia. The study evaluates whether multiple-choice examination questions generated using large language models (LLMs) perform comparably to traditionally human-written questions in medical education. Participants were randomized to complete one of two versions of a formative mock final examination consisting of 112 case-based single-best-answer multiple-choice questions (MCQs) aligned with the same course learning objectives. One exam version contained AI-generated questions produced using a structured LLM workflow with independent AI verification, while the other contained questions authored by senior medical students using conventional methods. The study evaluates exam feasibility, psychometric reliability, validity, student acceptability, and educational impact. Outcomes include exam performance, item discrimination indices, distractor efficiency, student perceptions of exam quality and difficulty, and changes in perceived preparedness for the upcoming summative examination.