Writing Quality MCQ
Writing high-quality test items begins with clearly-defined objectives for learning. For information on frameworks for creating educational objectives, click here.
The traditional multiple choice question (MCQ) format is the One-Best-Answer question, consisting of a single question with one best answer. This is the only question format used by the USMLE for the Step I examination.
The National Board of Medical Examiners provides an excellent document, The Guide to Constructing Written Test Questions for the Basic and Clinical Sciences. It is available here: http://www.nbme.org/about/itemwriting.asp The following information is drawn from this guide.
A Primer on Writing MCQs
Anatomy of the MCQ
- Stem: Contains the text
- Options: All answer choices
- Key: The correct answer
- Distractor: The incorrect options
Items should focus on important concepts and assess the application of knowledge – NOT recall of an isolated f
Test Item Formats
- DO NOT use true/false items
- The NBME has completely stopped using true/false formats on its exams.
- It may seem easier to write T/F questions than one-best-answer questions, but attempting to reduce ambiguity leads to testing recall only.
- DO NOT use negative A-type questions, e.g., “Each of the following is correct EXCEPT…”
- DO use one-best-answer items
Essentials for One-Best-Answer Items
- Invest in the stem: Ask a clear question!
- Include language in the stem instead of repeating it in each option
- Do not use negatively phrased items
- Do not use vague (e.g., many) or definitive (e.g., always) language
- Do not make the key longer than the distractors
- Answer options should use parallel grammatical structure
- Distractors must be plausible – use words familiar to students
- Order options in logical order (e.g., alpha or numeric)
- If you use “none of the above” use only when answers can be absolutely correct (e.g., historical date, math)
Resource: National Board of Medical Examiners. (2001). Constructing written test questions for the basic and clinical sciences. Philadelphia: NBME.
