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Writing Meaningful Test
Questions
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
Email: [email protected]
Twitter: @RyanMadanickMD
Blog: http://gutcheckblog.com
Phone: (919) 966-2513
Fax: (919) 843-2508
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Learning Objective
By the end of this session, learners should
be able to:
–Create a meaningful 1st order multiple
choice question using an objectivebased process
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Question Components
STEM
LEAD-IN
OPTIONS
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Question Components
ANSWER
OBJECTIVE
EXPLANATION
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Steps to Writing the MCQ
1.
2.
3.
4.
Determine the objective you are testing
Write the lead-in and options
Draft the stem
Write the explanation (if needed)
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Improving the Educational
Objective
• “Understand peptic ulcer disease”
What is wrong with this objective?
How could it be improved?
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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
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Action Verbs for Objectives
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Improving the Educational
Objective
• “Understand peptic ulcer disease”
What is wrong with this objective?
How could it be improved?
• 1st order: “Diagnose peptic ulcer disease”
• 2nd order: “Select the appropriate test for a
patient with suspected peptic ulcer disease”
• 3rd order: “Explain the mechanism of action
for a drug used to treat peptic ulcer disease”
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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
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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
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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)
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EXERCISE
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Write an objective for a potential
test question
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Write the lead-in and options for
your objective
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Draft the stem for your question
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Learning Objective
By the end of this session, learners should
be able to:
–Create a meaningful 1st order multiple
choice question using an objectivebased process
Special thanks to Amy Oxentenko, MD for some of these slides