MCQ MCQ Multiple Choice Questions

Why concern? • ยังคงมีการใช้อยู่ – ข้อสอบ comprehensive 4 สถาบัน – ข้อสอบ national test แพทยสภา • เชียงใหม่ ( ดูเหมือนจะ ) มีปัญหา – ภาควิชาส่วนใหญ่ ไม่มีระบบคัด กรองข้อสอบอย่างจริงจัง – สัดส่วนข้อสอบได้รับการคัดเลือก น้อย – ผลการสอบของ นศพ. เชียงใหม่ ไม่ สวยงามเท่าไรนัก

Why still be used? •reliability  •content validity  •practicality 

Why educator hate it? •poor MCQ –validity  •patient doesn’t come with choices! –lower order thinking •recall

First Conclusion •It still be used •National licensing examination –Part I: basic sc300 items –Part II: clinical sc450 items •We have to improve ourselves

How to construct? •planning •writing •reviewing and revising •publishing

How to improve? •knowledge •skill •attitude

Basic Knowledge •Theoretically; MCQ = –one best answer, + –matching, + –extended matching, + etc •Practically; –MCQ => one best answer

Planning •identify the outcome –Medical Council Standard –cognitive domain

Cognitive Domain knowledge comprehensive application analysis synthesis evaluation recall interpretation problem-solving Application recall

Planning •identify the outcome –Medical Council Standard –cognitive domain •identify number of item –time => 150 item : 180 min –formula •table of specification

Table of Specification สาระ น้ำหนัก ( รวม 100%) จำนวน ข้อสอบ ( รวม 300 ข้อ ) B1 General Principles33%100 B1.1Biochemistry and molecular biology10%10 B1.2Biology of cells10%10 B1.3Human development and genetics10%10 B1.4Biology of tissue response to disease10%10 B1.5Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environment 5%5

Table of Specification สาระ น้ำหนัก ( รวม 100%) จำนวน ข้อสอบ ( รวม 300 ข้อ ) B1 General Principles33%100 B1.6Multisystem processes10%10 B1.7Principles of specimen collections and laboratory interpretations 5%5 B1.8Pharmacodynamic and pharmacokinetic processes 10%10 B1.9Microbial biology and infection10%10 B1.10Immune responses10%10 B1.11Quantitative methods10%10

Table of Specification สาระ น้ำหนัก ( รวม 100%) จำนวน ข้อสอบ ( รวม 300 ข้อ ) B2 Hematopoietic and Lymphoreticular System7.4%22 B2.1Normal processes40%9 B2.2Abnormal processes40%9 B2.3Principles of therapeutics10%2 B2.4Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environment 10%2

Table of Specification •Cognitive taxonomy ratio –recall : application •basic sciences = 50:50 •body system = 30:70

Planning •identify the outcome –Medical Council Standard –cognitive domain •identify number of item –time => 150 item : 180 min –formula •table of specification

Writing •1 item = stem + options •stem •options / choices –1 answer / key –3-4 distracters •avoid testwiseness •avoid irrelevant difficulty

Good Stem •Valid •What? => TMC standard •Which aspect? => Form •How deep? => For GP

Good Stem •avoid –trivial fact •color reagent •enzyme –extreme recall •the second most common •the least common

Good Stem •1 stem = 1 aspect •No more –What are … and …? •Usually long stem + short options •Don’t teach in the test!

Good Stem •1 stem = 1 aspect •No more –What are … and …? •Usually long stem + short options •Don’t teach in the test!

Good Stem •Vignette + leading question Item template : Gross anatomy A (patient description) is unable to (functional disability). Which of the following is most likely to have been injured? A 65-year-old man has difficulty rising from a seated position and straightening his trunk, but he has no difficulty flexing his leg. Which of the following muscles is most likely to have been injured?

Good Stem Item template : A (patient description) has (history findings) and is taking (medications). Which of the following medications is the most likely cause of his (one history, PE or lab finding)? Item template : A (patient description) has a (type of injury and location). Which of the following structures is most likely to be affected?

Good Stem Item template : A (patient description) has (abnormal findings). Which [additional] finding would suggest/suggests a diagnosis of (disease 1) rather than (disease 2)? Item template : A (patient description) dies of (disease). Which of the following is most likely finding on autopsy?

Good Stem A patient has (abnormal findings) but (normal findings). Which of the following is the most likely diagnosis? Item template : A patient has (symptoms and signs). Which of the following is the most likely explanation for the (findings)?

Good Stem •Series of stems are fine –BUT independent

Good Stem •Should not –What do you think?

Good Stem •allow data gathering •provide a sizable data base •simulate reality •include appropriate “ noise ” •start with problem, not a diagnosis •use unfamiliar (not uncommon) case •test only cognitive objective •avoid diagnostic label

Good Options •same direction •similar length, otherwise –long answer + short distracters •similar style, otherwise –nice answer (copy from textbook) + poor distracters

Good Distractors •incorrect! •reasonable •common misunderstanding •common mistakes

Options Tidiness •sequencing –alphabetical –length –chronological –logical •word repeated

Testwiseness •grammatically guide •totally, absolutely, none, etc •latin translation •all of above, none of above, K type •question A => answer of question B

Unawares, the answer •is usually the option which is –longest –looked nicest –most understandable –appeared most frequent

Irrelevant difficulty •poor written, poor chart •double negative •too long, too complicated •difficult vocabulary, jargon •unordered number •subjective : often, usually •tricky

How to construct? •planning •writing •reviewing and revising –self-test –pilot / colleagues •publishing –readable

How to improve? •Knowledge •Skill •Attitude

Skill •Practicing –Form –Item development team –Item analysis

Miscellaneous •AI •p•p •r•r •item sequencing

Conclusion •Knowledge •Skill •Attitude