Blog: Phone: (919) Fax: (919) Ryan D. Madanick, MD Assistant Professor of Medicine Center for Esophageal Diseases and Swallowing (CEDAS) Division of Gastroenterology and Hepatology University of North Carolina School of Medicine Chapel Hill, NC Writing Meaningful Test Questions

Learning Objective By the end of this session, learners should be able to: – Create a meaningful 1 st order multiple choice question using an objective- based process

Question Components STEM OPTIONS LEAD-IN

Question Components OBJECTIVE EXPLANATION ANSWER

Steps to Writing the MCQ 1.Determine the objective you are testing 2.Write the lead-in and options 3.Draft the stem 4.Write the explanation (if needed)

Improving the Educational Objective “Understand peptic ulcer disease” What is wrong with this objective? How could it be improved?

The Objective Succinct sentence Specifies a clinical skill to be learned Uses action verbs to delineate a goal  Recognize, diagnose, treat, manage Avoid vague action verbs  Remember, recall, know Allows you to match curriculum

Action Verbs for Objectives

Improving the Educational Objective “Understand peptic ulcer disease” What is wrong with this objective? How could it be improved? 1 st order: “Diagnose peptic ulcer disease” 2 nd order: “Select the appropriate test for a patient with suspected peptic ulcer disease” 3 rd order: “Explain the mechanism of action for a drug used to treat peptic ulcer disease”

The Lead-In Keep Lead-In generic – What is the best next step in management? Use relative terms – What is the most likely diagnosis? Avoid negative lead lines – Which of the following is the LEAST LIKELY diagnosis? Watch for syntax/grammar cues “Cover the options” rule

Options Avoid mutually exclusive options  Increases/decreases  Always/never; stop/continue Each option should test one concept  Drug OR dose OR route OR duration Keep options brief; similar in length Options should be homogeneous  Length, complexity

The Stem Chronologic order of presentation  Age, gender (avoid race unless needed)  Site of visit (ER, clinic, hospital)  Chief complaint (add features)  PMH/Meds/FH/SH (relevant or distracter)  Vitals/Exam/Labs/Tests (pertinent)

EXERCISE

Write an objective for a potential test question

Write the lead-in and options for your objective

Draft the stem for your question

Learning Objective By the end of this session, learners should be able to: – Create a meaningful 1 st order multiple choice question using an objective- based process Special thanks to Amy Oxentenko, MD for some of these slides