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AI-enhanced adaptive testing with cognitive diagnostic feedback and its association with performance in undergraduate surgical education: a pilot study

datacite.subject.sdg04:Educação de Qualidade
datacite.subject.sdg03:Saúde de Qualidade
datacite.subject.sdg09:Indústria, Inovação e Infraestruturas
dc.contributor.authorGonçalves, Nuno Silva
dc.contributor.authorCollares, Carlos
dc.contributor.authorPêgo, José Miguel
dc.date.accessioned2026-03-04T11:36:50Z
dc.date.available2026-03-04T11:36:50Z
dc.date.issued2026-01-06
dc.description.abstractBackground: Effective feedback in the cognitive domain is essential for surgical education but often limited by resource constraints and traditional assessment formats. Artificial Intelligence (AI) has emerged as a catalyst for innovation, enabling automated feedback, real-time cognitive diagnostics, and scalable item generation, thereby transforming how future surgeons learn and are assessed. Methods: An item bank of 150 multiple-choice questions was developed using AI-assisted item generation and difficulty estimation. A formative Computerized Adaptive Testing (CAT), balanced across three cognitive domains (memory, analysis, and decision) and surgical topics, was delivered via QuizOne® 3–5 days before the summative Progress Test. A total of 147 students participated, of whom 116 completed the formative CAT. Performance correlations, group comparisons, analysis of covariance (ANCOVA), and regression analyses were conducted. Results: Students who voluntarily completed CAT showed higher Progress Test scores, though causality cannot be established due to self-selection bias (p = 0.021), with the effect persisting after adjusting for prior academic performance (ANCOVA p = 0.041). Memory skills were the strongest predictors of summative outcomes (R2 = 0.180, β = 0.425), followed by analysis (R2 = 0.080, β = 0.283); decision was not significant (R2 = 0.029, β = 0.170). Conclusion: AI-enhanced CAT–Cognitive Diagnostic Modeling (CDM) represents a promising formative approach in undergraduate surgical education, being associated with higher summative performance and providing individualized diagnostic feedback. Refining feedback presentation and enhancing decisionmaking assessment could further optimize its educational impact.eng
dc.identifier.doi10.3389/fnbeh.2025.1735237
dc.identifier.issn1662-5153
dc.identifier.urihttp://hdl.handle.net/10400.1/28321
dc.language.isoeng
dc.peerreviewedyes
dc.publisherFrontiers Media SA
dc.relation.ispartofFrontiers in Behavioral Neuroscience
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectArtificial intelligence
dc.subjectComputerized adaptive testing
dc.subjectCognitive diagnostic modeling
dc.subjectSurgical education
dc.subjectFeedback
dc.subjectCognitive skills
dc.subjectAssessment innovation
dc.subjectEducational technology
dc.titleAI-enhanced adaptive testing with cognitive diagnostic feedback and its association with performance in undergraduate surgical education: a pilot studyeng
dc.typejournal article
dspace.entity.typePublication
oaire.citation.titleFrontiers in behavioral neuroscience
oaire.citation.volume19
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85
person.familyNameCollares
person.givenNameCarlos
person.identifier.ciencia-id081D-E544-658E
person.identifier.orcid0000-0003-0914-3430
relation.isAuthorOfPublication7961b10d-6495-41d7-b9a3-5fb549e191c1
relation.isAuthorOfPublication.latestForDiscovery7961b10d-6495-41d7-b9a3-5fb549e191c1

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