The confidence level (information-referenced testing; IRT) design is an attempt to improve upon the multiple choice format by allowing students to express a level of confidence in the answers they choose. In this study, the author evaluated student perceptions of the ease of use and accuracy of and general preference for traditional multiple choice, confidence-level, and essay format questions. The author estimated the relative accuracy of traditional multiple choice vs. confidence level compared with the essay results and the student self-reported mastery of knowledge domains. Student acceptance of the new format was equal to, and accuracy was better than, the traditional format. (Contains 4 tables.)