Research has suggested that changing one's answer on multiple-choice examinations is more likely to lead to positive academic outcomes. This study aimed to further understand the relationship between changing answer selections and item attributes, student performance, and time within a population of 158 first-year medical students enrolled in a gross and developmental anatomy course at an academic medical institution in the United States. For each student, answer changes, overall exam performance, and individual item performance data were retrieved from an online testing software for a single block exam. Researchers determined how many times students changed their answers, the associated outcomes, and time spent on each item and the entire exam in relation to item performance. Students in the highest performing quartiles were more likely to keep their initial answer selection, spent more time choosing their initial answer selection, and averaged a higher total exam time than each of the lowest two performance quartiles. Time on individual items and answer changes had a statistically significant relationship, with more time relating to the presence of an answer change. Changing an answer selection was more likely to result in a negative outcome. The content subject was significant in relation to answer changes and time spent per item. This study provides a deeper understanding into which factors, such as item attributes, time, and performance of the student, showed statistically significant relationships to answer changing.