MCQ MCQ CONSTRUCTIONCONSTRUCTION

Raja C. Bandaranayake

STAGESSTAGES

A. Plan the question B. Write the question

C. Test the question

A. Plan the question

Ensure question deals with an important and useful aspect of the subject

Avoid trivia Include:

Common issues Serious conditions Important or frequent misunderstandings

Appropriate to expected level

Test knowledge around a central theme

Be clear about exactly what fact, concept or generalization is being tested

This central theme should be clearly defined in the stem

All options should refer to this theme

Decide on the ability you wish to test

Recall or recognition Interpretation Problem-solving

A child has gashed the palmar aspect of her wrist. Which of the following would be evidence of damage to her median nerve?

A. inability to flex distal interphalangeal joint of the index fingerB. inability to flex interphalangeal joint of the thumbC. loss of sensation on palmar aspect of the little fingerD. inability to oppose the thumb to the little fingerE. inability to abduct the index finger

Consider how the information should be presented

Word description Photograph Radiograph Tracing (e.g. ECG, visual field) Diagram (e.g. anatomical) Movie film Amplified sound (e.g. heart sounds)

B. Write the question

Use simple and clear language

Avoid unfamiliar technical or unusual words

Check for ambiguity amongst fellow examiners or students

Anxious examinees imagine traps in questions

Write stem as a question or incomplete statement

If a question, each option must be a possible answer

If an incomplete statement, each response must follow grammatically and logically from the stem; i.e. stem + each option must be a complete statement

Avoid stems with just one or two words:

Hair:

A. growth in man shows the phenomenon of asynchronous cyclic growth.B. ……………

Keep reading time to a minimum

Include only material or explanations necessary for answering the question

In considering your management of a 28-year-old fashion designer with bleeding from the nose, you would be aware that the most frequent cause of epistaxis at any age is

A. ………………

Make the responses clear and concise

If a response requires a large number of words to qualify what is meant by it, the questions is probably too complex for an MCQ

Include all common elements in the stem

The third part of the duodenum

A. is anterior to the uncinate process of the pancreasB. is anterior to the common bile ductC. is anterior to the right ureterD. is anterior to the superior mesenteric arteryE. is anterior to the inferior mesenteric vein

Avoid clues to the correct answer

Use of stereotyped or standard phraseology“the pituitary gland is the master of the endocrine orchestra”

Unequal length of alternatives Obvious inconsistencies between stem and a response

An intercostal tube may be placed in a patient with a flail chest but without a pneumothorax or haemothorax to

A. remove airB. remove bloodC. prevent onset of pulmonary contusionD. prevent development of a tension pneumothorax when the patient is placed on positive pressure ventilationE. eliminate paradoxical movement of the flail segment

Avoid clues to the correct answer [contd]

Using opposite of the correct answer as a distractorParalysis of a vocal cord in a patient with bronchogenic carcinoma is most likely to be

A. bilateralB. on the right sideC. on the left sideD. due to metastasis to the larynxE. due to cigarette smoking

Use of absolutes (e.g. “always”, “only”, “never”)Adamantinoma of the mandible

A. never metastasizeB. usually metastasize to lymph nodesC. …………

Avoid clues to the correct answer [contd]

Use of synonyms or overlapping alternatives Use of similar distractors, making the correct

response more conspicuous

Antidiuretic hormone is synthesized

A. the anterior lobe of the pituitary glandB. the posterior lobe of the pituitary glandC. the pars intermedia of the pituitary glandD. the pars nervosa of the pituitary glandE. the hypothalamus

Use plausible and logical distractors

Obvious distractors increase chances of guessing

Derive distractors from common errors made by students

Derive distractors from common misconceptions held by students

If legitimate distractors cannot be found, recast question in a different format

Use eponyms, acronyms and abbreviations only if you expect students to know them

Eponym: Named after a person (e.g. pouch of Douglas; Meckel’s diverticulum)

Acronym: Combination of first letters (e.g. ACTH, CK)

Abbreviation: Shorter form of a word (e.g. ht. sd.)

Specify units

Particularly when using laboratory units, as they can vary from one laboratory to another

The normal range for a given laboratory may have to be quoted

Indicate opinion or authority if dealing with unestablished facts

Indicate whose opinion or what authority the question is based on

According to the passive equilibrium model of Kokko (1975) the main factor responsible for the concentration of urine in the loop of Henle is

A. the relative impermeability of the descending limb of the loop of Henle to sodium chloride

B. the movement of urea out of the apex of the loop of HenleC. …………

Minimize negatively phrased questions

Avoid double negatives They confuse examinees If absolutely necessary, emphasize the word(s)

conveying a negative aspect by using capitals or underlining

Haematemesis is not unexpected in each of the following, except

A. ………B. ………C. ………

Beware of unintentionally asking two questions in the same option

Avoid especially if the answer to one is ‘true’ and to the other is ‘false’.

Psychological process and gastrointestinal function are

A. clearly separable and rarely correlatedB. ………

Avoid “all of the above” and beware of “none of the above”

After partial gastrectomy, gastric emptying is abnormal because

A. the pylorus is removedB. there is interference with the pacemakerC. the gastric remnant is smallerD. all of the aboveE. none of the above

C. Test the question

Get agreement from fellow examiners that: the question is worth asking it is clearly and unambiguously stated distractors are reasonable and plausible

Test the question on students if possible may represent a different interpretation of the

question may reveal what the question was actually

testing may have an opinion on importance and validity can indicate their answering strategy may point out errors in the question