Background: The widespread use of multiple choice questions (MCQ) in examinations is attributed to its logistical advantage and broad coverage of content within a short duration. The end-of-semester examinations for several modules in the pharmacy programme previously employed a combination of written examination tools including MCQ, short answer questions (SAQ) or essays for assessing learning outcomes in the cognitive domain. Concerns regarding assessment fatigue and subjectivity in marking have led to a review of the assessment formats in the examinations. Various types of MCQ were consequently introduced as the only assessment tool. This study was conducted to evaluate the performance of students in the examinations as a result of the change. Methodology: Analyses were carried out on the end-ofsemester examination results of two cohorts of students for each module, one based on a combination of MCQ, SAQ or essay and the other based on MCQ alone. The class means were compared, and t-test was used to determine the difference between the performances. Results: Although the difference in the mean scores of the two groups is statistically significant in 13 of the 20 modules, the difference is less than 5% in 10 modules. Conclusion: The findings provide evidence that wellconstructed MCQ can effectively assess cognitive skills.