1. Student Assessment Committee Undergraduate Program
Guidelines for preparing Multiple Choice Questions (MCQ’s) for PBL Tutors
Student Assessment Committee
Undergraduate Program

2. Why write a Question? Recognizes a role for tutors
Recognizes the importance of Assessments
Focuses tutors on the Learning Objectives
Emphasizes application of knowledge and the Problem Solving Process
Contribution to the Item Bank is documented for inclusion in Teaching Dossier
Contributors names are submitted for a ‘Prize’ draw

3. How? References available:
Case and Swanson, NBME “Constructing Questions for the Basic and Clinical Sciences”
publications, item writing manual
Royal College of Physicians and Surgeons of Canada website
rcpsc.medical.org- publications and documents-material for examiners

4. How? One-Best Answer Item
Composed of a “stem’ and generally 5 “distractors”, one of which is the correct response
Acute intermittent porphyria is the result of a defect in the biosynthetic pathway for:
A. collagen
B. corticosteroid
C. fatty acid
D. glucose
E. heme

5. How to do it better?
A better question is one that uses a clinical case vignette as the stem:
An otherwise healthy 33 year-old man has mild weakness and occasional episodes of steady, severe abdominal pain with some cramping and no diarrhea. One aunt and a cousin have had similar episodes. During an episode, his abdomen is distended, and bowel sounds are decreased. Neurological examination shows mild weakness in the upper arms. These findings suggest a defect in the biosynthetic pathway for
A. collagen
B. corticosteroid
C. fatty acid
D. glucose
E. heme

6. Good MCQ’s * Assess application of knowledge
Present a homogeneous set of options

7. The Basic Rules for One-Best-Answer Items
1. Each item should focus on an important concept
Common, serious or potentially catastrophic clinical problem
Avoid :
Tricky
Trivial
Overly complex
Case and Swanson, 2001

8. The Basic Rules for One-Best-Answer Items
2. Each item should assess the application of knowledge NOT recall of an isolated fact
Clinical case vignettes provide a good basis for a question
Stems may be longer
Options should be short
Case and Swanson, 2001

9. Application of knowledge vs. Isolated Fact
What area is supplied with blood by the posterior inferior cerebellar artery?
A 63-year old man develops left-sided limb ataxia, Horner’s syndrome, nystagmus, and loss of appreciation of facial pain and temperature sensations. What artery is most likely to be occluded?
Case and Swanson, 2001

10. The Basic Rules for One-Best-Answer Items
3. The stem of the item must pose a clear question
It should be possible to arrive at an answer with the options covered
Case and Swanson, 2001

11. The Basic Rules for One-Best-Answer Items
4. All distractors (incorrect options) should be homogeneous
Correct and incorrect options should fall into the same category (all diagnoses, tests, treatments, etc)
Case and Swanson, 2001

12. Distractors Should be:
Plausible
Grammatically consistent
Logically compatible
Same relative length as the correct answer
Order the options in logical order (numeric) or alphabetical
Case and Swanson, 2001

13. The Basic Rules for One-Best-Answer Items
5. Avoid “technical item flaws” that provide special benefit to test-wise examinees or that pose irrelevant difficulty
Case and Swanson, 2001

14. Example Technical Item Flaws
In patients with advance dementia, Alzheimer’s type, the memory defect
A. can be treated adequately with phosphatidylcholine (lecithin)
B. could be a sequela of early parkinsonism
C. is never seen in patients with neurofibrillary tangles at autopsy
D. is never severe
E. possibly involves the cholinergic system

15. Possible changes
In patients with advance dementia, Alzheimer’s type, the memory defect can be effectively treated with
A. cholinergic agonists
B. dopaminergic agonists
C. GABA agonists
D. nicotinic agonists
E. serotonergic agonists

16. The Basic Rules for One-Best-Answer Items
Subject each question you write to the above 5 “tests”
If a question passes all 5, it is probably well-written and focused
Case and Swanson, 2001

17. What?
Each tutor is asked to construct at least two questions during the block.
Each question will be based on one of the weekly case objectives

18. Where?
Please or provide a paper copy of your questions prior noon of the last Friday of the block to:
this presenter;

19. Final Check? Please remember to include:
The learning objective the question is testing
The case scenario
The answer to the question
If you can only write 2 – or only parts of the question - that is OK. Your questions will be reviewed with feedback to you before submission to the examination.