Cognitive Level Coding as a Predictor of Item Discrimination: An Empirical Study in Anesthetic Pharmacology Education

Background Bloom's taxonomy is widely used to classify examination items by cognitive level, yet its predictive validity for item discrimination remains understudied in pharmacology education. This study investigated whether cognitive level coding predicts item discrimination in an anesthetic pharmacology examination. Methods This retrospective document analysis examined 58 items from a final anesthetic pharmacology examination completed by 194 undergraduate students. Two independent raters coded items using a modified three-level Bloom's taxonomy (recall, interpretation, problem-solving). Item difficulty (P) and discrimination (D) indices were extracted from the official test analysis report. Predictive validity was assessed using Spearman correlation, linear regression, and one‑way ANOVA. Items with D < 0.10 underwent distractor analysis and cognitive attribution. Results The examination demonstrated excellent reliability (Cronbach's α = 0.91), moderate difficulty (P = 0.68), and good overall discrimination (D = 0.45). Cognitive level was positively correlated with item discrimination (rₛ = 0.42, 95% CI [0.18, 0.61], P  < 0.01), explaining 16.8% of the variance (R² = 0.168). Problem‑solving items exhibited higher discrimination (0.49 ± 0.18) than recall items (0.34 ± 0.22) (η² = 0.14, P  = 0.03). Five items (8.6%) showed low discrimination (D < 0.10), predominantly at the recall level, and were compromised by ceiling effects, dysfunctional distractors, or strong‑distractor‑induced empirical error. Conclusions Cognitive level coding significantly predicts item discrimination in anesthetic pharmacology assessments, with problem‑solving items demonstrating superior discriminatory power. However, predictive validity depends on item‑writing quality. Integrating cognitive blueprints into examination design and refining distractors using empirical data are recommended to enhance assessment quality in pharmacology education. Clinical trial number Not applicable.