This retrospective study compared the performance of medical students in multiple choice questions (MCQs) and short essay questions (SEQs). During the 3 year analysis, 533 students had an average score of 51.34% (SD 9.9) in the SEQ and 64.71%(SD 9.9)in the MCQs. Regression analysis showed a significant correlation(r=0.64, P<0.01) between MCQs and SEQs. When student performance was grouped by final course grade, a statistically significant correlation between MCQs and SEQs scores existed only for the 405 students who received a passing grade (r=0.21, P<0.01). The MCQ and SEQ scores were not correlated for the 128 students who failed (r=0.11, P=0.08) or for 70 students who achieved distinctions (r=-0.27, P=0.13). MCQ scores were significantly higher (P<0.01) than SEQ for each of the groups when analyzed by the two-way ANOVA test. The result of this study suggests that for most students, the strong correlation between MCQ and SEQ indicates that student performance was independent of testing format. For students at either end of the performance spectrum, the lack of correlation suggests that the performance in one of the testing format had a strong influence on the final course grade. In addition, those students who failed the course were likely to be weak in both testing modalities, whereas students in all grade groups were more likely to perform better in the MCQs than SEQs.