Challenge: Medical multiple-choice question answering (MCQA) requires high accuracy to be useful in practice.
Approach: They propose to focus masked language modeling on disease name prediction when using medical encyclopedic paragraphs as input.
Outcome: The proposed model outperforms the masked language model on disease name prediction and masks the cues to the answers.

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Clues Before Answers: Generation-Enhanced Multiple-Choice QA (2022.naacl-main)

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Challenge: Multiple-choice question answering (MCQA) uses text-to-text framework . but, there is an under-utilization of the decoder and knowledge that can be decoded .
Approach: They propose a generative multiple-choice question answering model which generates a clue from the question and leverages it to enhance a reader for MCQA.
Outcome: The proposed model outperforms text-to-text models on multiple MCQA datasets.
DisGeM: Distractor Generation for Multiple Choice Questions with Span Masking (2024.findings-emnlp)

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Challenge: Multiple-choice cloze tests are a prevalent form of assessment that evaluates students' comprehension and inference abilities.
Approach: They propose a framework for distractor generation using readily available pre-trained language models . human evaluations confirm that their approach produces more effective distractors .
Outcome: The proposed framework outperforms existing methods without training or fine-tuning human evaluations confirm it.
When Models Decide and When They Bind: A Two-Stage Computation for Multiple-Choice Question Answering (2026.findings-acl)

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Challenge: Multiple-choice question answering (MCQA) is easy to evaluate but adds a meta-task . prior work has shown that language models exhibit selection biases for particular option identifiers such as the label "A"
Approach: They find that option-boundary residual states contain strong linearly decodable signals . winning content position becomes decoded after final option is processed .
Outcome: The proposed model solves the problem and outputs the symbol that represents the answer.
Which of These Best Describes Multiple Choice Evaluation with LLMs? A) Forced B) Flawed C) Fixable D) All of the Above (2025.acl-long)

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Challenge: Multiple choice question answering (MCQA) is popular for LLM evaluation due to its simplicity and human-like testing.
Approach: They argue for a reform of multiple choice question answering (MCQA) they argue for more generative formats based on human testing .
Outcome: The proposed reforms improve the quality of MCQA, the authors argue . they show that even when MCQ is a useful format, its datasets suffer from leakage, unanswerability, shortcuts and saturation.
To Generate or to Retrieve? On the Effectiveness of Artificial Contexts for Medical Open-Domain Question Answering (2024.acl-long)

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Challenge: Medical open-domain question answering requires substantial access to specialized knowledge.
Approach: They propose a framework that generates multiple-choice questions from a set of open-book parameters and a small-scale reader that can outcompete closed-book questions by 706x using fewer parameters.
Outcome: The proposed framework outperforms closed-book models on MedQA-USMLE, MedMCQA, and MMLU while using up to 706x fewer parameters.
Pattern Recognition or Medical Knowledge? The Problem with Multiple-Choice Questions in Medicine (2025.acl-long)

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Challenge: Large Language Models (LLMs) are often evaluated using multiple-choice questions (MCQs) modeled on exams like the USMLE.
Approach: They created a fictional medical benchmark centered on an imaginary organ, the Glianorex, to separate memorized knowledge from reasoning ability.
Outcome: The proposed model outperforms base models in English but not in French.
Artifacts or Abduction: How Do LLMs Answer Multiple-Choice Questions Without the Question? (2024.acl-long)

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Challenge: Multiple-choice question answering (MCQA) is often used to evaluate large language models . a recent study found that LLMs perform MCQA with choices-only prompts .
Approach: They investigate whether LLMs can perform multiple-choice question answering (MCQA) with choices-only prompts . they find no evidence that the choices- only accuracy stems from memorization alone .
Outcome: The results show that LLMs perform MCQA with choices-only prompts with 0.33 accuracy gain.
Can We Learn Question, Answer, and Distractors All from an Image? A New Task for Multiple-choice Visual Question Answering (2024.lrec-main)

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Challenge: Existing studies focus on generating QADs from image and question, but a novel task is needed to generate meaningful questions, correct answers, and challenging distractors.
Approach: They propose a task to generate QADs from images and encode images together . they use contrastive learning to ensure consistency of QAD generated and tested .
Outcome: Empirical evaluations on the benchmark dataset validate the performance of the proposed task.
ReMedQA: Are We Done With Medical Multiple-Choice Benchmarks? (2026.eacl-long)

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Challenge: Multiple-choice question answering (MCQA) benchmarks show near-human accuracy . but a single accuracy score is a poor proxy for competence .
Approach: They propose a medical multiple-choice question answering (MCQA) benchmark that augments three standard medical MCQA datasets with open-ended answers and systematically perturbed options.
Outcome: The proposed benchmarks show that high MCQA accuracy masks low reliability . MCQ is the dominant paradigm for assessing medical knowledge in large language models .
Multi-modal Concept Alignment Pre-training for Generative Medical Visual Question Answering (2024.findings-acl)

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Challenge: Medical Visual Question Answering (Med-VQA) aims to provide accurate answers to questions regarding medical images, a task particularly challenging for open-ended questions.
Approach: They propose a multi-modal concept alignment pre-training approach for generative Med-VQA that leverages a knowledge graph sourced from medical image-caption datasets and the Unified Medical Language System.
Outcome: The proposed approach significantly outperforms existing methods on a set of benchmark datasets and shows high efficiency and knowledge-image alignment capability.

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