Using a Hybrid of AI and Template-Based Method in Automatic Item Generation to Create Multiple-Choice Questions in Medical Education: Hybrid AIG

Background: Template-based automatic item generation (AIG) is more efficient than traditional item writing but it still heavily relies on expert effort in model development. While nontemplate-based AIG, leveraging artificial intelligence (AI), offers efficiency, it faces accuracy challenges. Medical education, a field that relies heavily on both formative and summative assessments with multiple choice questions, is in dire need of AI-based support for the efficient automatic generation of items. Objective: We aimed to propose a hybrid AIG to demonstrate whether it is possible to generate item templates using AI in the field of medical education. Methods: This is a mixed-methods methodological study with proof-of-concept elements. We propose the hybrid AIG method as a structured series of interactions between a human subject matter expert and AI, designed as a collaborative authoring effort. The method leverages AI to generate item models (templates) and cognitive models to combine the advantages of the two AIG approaches. To demonstrate how to create item models using hybrid AIG, we used 2 medical multiple-choice questions: one on respiratory infections in adults and another on acute allergic reactions in the pediatric population. Results: The hybrid AIG method we propose consists of 7 steps. The first 5 steps are performed by an expert in a customized AI environment. These involve providing a parent item, identifying elements for manipulation, selecting options and assigning values to elements, and generating the cognitive model. After a final expert review (Step 6), the content in the template can be used for item generation through a traditional (non-AI) software (Step 7). We showed that AI is capable of generating item templates for AIG under the control of a human expert in only 10 minutes. Leveraging AI in template development made it less challenging. Conclusions: The hybrid AIG method transcends the traditional template-based approach by marrying the "art" that comes from AI as a "black box" with the "science" of algorithmic generation under the oversight of expert as a "marriage registrar". It does not only capitalize on the strengths of both approaches but also mitigates their weaknesses, offering a human-AI collaboration to increase efficiency in medical education.