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PREPARING EFFECTIVE MULTIPLE CHOICE EXAMINATION QUESTIONS. PATRICK DUFF, M.D. LEARNING OBJECTIVES. Describe the levels of complexity of an examination question Describe the types of examination questions Describe desirable and undesirable features of examination questions.
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PREPARING EFFECTIVE MULTIPLE CHOICE EXAMINATION QUESTIONS PATRICK DUFF, M.D.
LEARNING OBJECTIVES • Describe the levels of complexity of an examination question • Describe the types of examination questions • Describe desirable and undesirable features of examination questions
EXAMPLERECALL • Which of the following is the most important risk factor for squamous cell carcinoma of the lung? A. Age > 50 B. Diabetes C. Smoking D. Obesity
EXAMPLEINTERPRETATION • A 24 year old nulliparous woman at 16 weeks gestation had the following values on her serum analyte screening test: AFP …below the mean HCG…above the mean Estriol…below the mean Inhibin…above the mean
EXAMPLE INTERPRETATION • Which of the following chromosome abnormalities is her baby most likely to have? A. Triploidy B. Trisomy 21 C. 45, X D. Trisomy 18
EXAMPLEINTERPRETATION • A term neonate has hepatosplenomegaly, thrombocytopenia, and the diffuse rash noted in the photograph.
EXAMPLEINTERPRETATION • Which congenital infection is most likely? • A. Parvovirus • B. CMV • C. HIV • D. Mumps
EXAMPLEPROBLEM SOLVING • A 22 year old male has a 48 hour history of malaise, fever (39 deg C), shaking chills, and cough productive of rust-colored sputum. On physical examination, there is dullness to percussion in the lower left lung field, and tubular breath sounds can be heard in this area.
EXAMPLEPROBLEM SOLVING • Which of the following is most appropriate for treatment of this patient? A. Isoniazid B. Fluconazole C. Ceftriaxone D. Acyclovir
GUIDELINES FOR AN EFFECTIVE TYPE-A QUESTION • Determine a single clear objective prior to writing the question • Have only one objective per question • Make sure the question is at an appropriate level of difficulty for the target audience
GUIDELINES FOR AN EFFECTIVE TYPE-A QUESTION • Correct response should be obvious to the well-informed examinee before the answers are read • If the examinee has to read all of the answers before deciding, the question is probably a K-type “disguised” as an A-type
TYPE A QUESTIONGOOD EXAMPLE • Which of the following is the most common complication of multiple pregnancy? A. Gestational diabetes B. Placenta previa C. Postpartum hemorrhage D. Preterm delivery
BEWARE THE PSEUDO-A QUESTION • All of the following statements about preterm delivery are true except • The frequency is 10 %. • It can be prevented by use of progesterone. • It is more common in whites than in African-Americans. • It may result in neonatal RDS.
GUIDELINES FOR AN EFFECTIVE TYPE-A QUESTION • Include sufficient information in the stem, but avoid unnecessary verbiage • Be certain the question has a clear, unambiguous answer
GUIDELINES FOR AN EFFECTIVE TYPE-A QUESTION • Include 4 to 5 possible answers • Be certain the incorrect answers are reasonably plausible
TYPE A QUESTIONBAD EXAMPLE • What is the risk of pregnancy loss after a second trimester amniocentesis? A. 0.5% B. 10 % C. 25 % D. 50 %
GUIDELINES FOR AN EFFECTIVE TYPE-A QUESTION • Do not use “none of the above” or “all of the above” as distractors • Confusing • Rewards guessing
GUIDELINES FOR AN EFFECTIVE TYPE-A QUESTION • Avoid clues in the responses such as answers of unequal length or repetition of key words
GUIDELINES FOR AN EFFECTIVE TYPE-A QUESTION • Avoid compound answers, ie, answers that include multiple actions
TYPE A QUESTIONBAD EXAMPLE • Which of the following is the most appropriate treatment for community-acquired pnemonia? • A. Clindamycin • B. Vancomycin • C. Valacyclovir • D. Administer oxygen, check blood gases, and administer levofloxacin
GUIDELINES FOR AN EFFECTIVE TYPE-A QUESTION • Be wary of “except” type questions, especially when a “double negative” is present
GUIDELINES FOR AN EFFECTIVE TYPE-A QUESTION • In certain instances, an “except” type question may be appropriate and may accurately assess the breadth of an examinee’s knowledge
TYPE A QUESTIONGOOD EXAMPLE • All of the following are risk factors for gestational diabetes except A. Obesity B. Positive family history C. Age < 25 y D. History of a macrosomic child
GUIDELINES FOR AN EFFECTIVE TYPE-A QUESTION • Be certain that illustrative materials are clear and that they reproduce well • Vary the correct response among the letters a - d
GUIDELINES FOR AN EFFECTIVE TYPE-B QUESTION • Clearly identify the nature of the items in column A and column B • Include at least 1 or 2 unused distractors
GUIDELINES FOR AN EFFECTIVE TYPE-B QUESTION • Indicate if answers in one of the columns may be used only once, more than once, or not at all • Be certain the matching items are reasonably related to one another
GUIDELINES FOR AN EFFECTIVE TYPE-B QUESTION • Matching items are particularly useful for testing interpretation skills • X-ray • ECG • Sonogram • Histology
CONCLUSIONS • Use only type-A and type-B questions • Minimize recall questions and maximize questions that test interpretive and problem-solving skills
CONCLUSIONS • Be certain that each question has a single and specific objective • Be certain the questions can be answered in the time allotted