Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/304349657
CITATIONS READS
0 3,023
3 authors, including:
Some of the authors of this publication are also working on these related projects:
Dietary Practices and Barriers to Dietary Modification among Diabetics and Hypertensive in a Rural
Health Service Area of Puducherry - A Qualitative Study View project
All content following this page was uploaded by Sitanshu Sekhar Kar on 24 June 2016.
Abstract
Multiple Choice Questions (MCQs) are one of the most important well established tools used for assessment and
selection processes in medical education. Designing good assessment tools requires time and effort and ultimately
determines the learning outcome. The quality of MCQ depends on the quality of items on the whole and presence
of efficient distractors. Flawed MCQs interfere with assessment process and therefore it is vital to develop reliable
and valid items that are free of such flaws. Basic criteria for constructing good quality MCQs include item content
that is tested and well-structured, flawless items. Three areas that are addressed in this article include general
guidelines of using MCQ inevaluation, principles of constructing effective MCQs, and constructing higher order
MCQs. Characteristics of effective MCQs are determined by the overall item, the stem and distractors. Interpretation
and problem-solving items like MCQs with data, diagrams and images, use of clinical or lab vignettes, formats like
Extended Matching items, Key feature questions and assertion reason questions require higher order thinking skills
like analysis, synthesis and evaluation. Significant commitment and technical knowhow is required to prepare MCQs
that are of good quality, reliable, able to test higher order thinking skills and consistent with curriculum objectives.
Constructing MCQs is an art which can be perfected with practice and it is essential for medical educators to be
skilled in effective test item writing to assess the learner’s knowledge.
MCQs are used most commonly for formative assessment and Basic structure of MCQs
selection processes. Appropriately constructed MCQ based
methods are efficient, objective, capable of discrimination The basic MCQ or ‘item’ is one in which the candidate
and can be combined with other assessment strategies to chooses one answer from a set of options provided (Single
contribute to a comprehensive student assessment strategy.4 best response type). An item consists of a ‘stem’ followed
by a number of options. Sometimes the stem is followed
Similar to other methods of assessment, they have their by the ‘lead in question’. The correct answer in the list of
advantages and limitations. A distinct advantage of using options is called a ‘key’ and the incorrect options are called
MCQ is its ability to evaluate a large number of candidates ‘distractors’.3
Address for Correspondence: Dr. Sitanshu Sekhar Kar, Associate Professor, Dept. of Preventive and Social Medicine, JIPMER,
Puducherry,India- 605006. Email: drsitanshukar@gmail.com Received: 07.06.2015, Accepted: 22.07.2015
Indian Journal of Community & Family Medicine | Vol. 1 | Issue 02 | Jul-Dec, 2015 65
Kar S S: Basic principles of constructing multiple choice questions
Indian Journal of Community & Family Medicine | Vol. 1 | Issue 02 | Jul-Dec, 2015 66
Kar S S: Basic principles of constructing multiple choice questions
A. GENERAL GUIDELINES FOR USING MCQs IN 4. Time allotment for examination needs due
EVALUATION9 : consideration. Different item formats require different
time duration (single response - 40 seconds, whereas
1. Scope of the examination and learning outcomes case history type – 60 to 90 seconds).
being tested should be clear before formulating an
assessment strategy. 5. Negative marking and guessing correction are
important issues that need to be addressed keeping
2. Cognitive levels being tested should be decided as the the objective of assessment in mind.
format of MCQ may depend on this fact.
6. Fixation of pass level in MCQ examination is more
3. Sufficient number of items isrequired for a valid difficult than other formats. Though several formats
MCQ examination that covers a specific topic; probably are available, MCQs function much better for the
60-100 items are optimal for an examination of 60-90 purpose of ranking.
minutes duration.
7. Validation process is an important step in formulation
Indian Journal of Community & Family Medicine | Vol. 1 | Issue 02 | Jul-Dec, 2015 67
Kar S S: Basic principles of constructing multiple choice questions
of MCQs. Prevalidation (before the item appears in an C. CONSTRUCTING HIGHER ORDER MCQs
examination) and post validation (item analysis after
the test) are essential to ensure validity of the item. MCQ shouldtest the appropriate level of learning and ensure
assessment of intended learner competence. Bloom’s
8. Instructions to candidates on how to respond to taxonomy ofcognitive learning,described as a hierarchy of
individual items, time allotment and negative marking, knowledge, comprehension, application,analysis, synthesis,
if any, should be clearly outlined in the beginning of and evaluation, has been adopted for test development.7
the paper.
Traditionally, items are classified by the cognitive processes
B. CONSTRUCTING EFFECTIVE MCQs: 1,8,6,10 required to answer the question (eg, recall, interpretation,
problemsolving, comprehension, or reasoning). Recall
Constructing multiple choice questions is a laboriously items are thought to test examinees’ knowledge of isolated
acquired art, and it is much easier to advise how not facts.Interpretation items require examinees to review
towrite them than to give a simple way of writing them. some information (often in tabular or graphical form) and
The questionsshould be relevant, short, understandable reach some conclusion(eg, a diagnosis). Problem-solving
and discriminant.11 It is worth following a checklist items present a situation and require examinees to take
whileformulating MCQs (Table 2). some action (eg, the next step in patient management).
Interpretation and problem-solving items are thought to
Prevalidation of the items can be done by discussion with
involve “higher order” skills, rather thanjust rote memory
three or four experts on the relevance to learning outcome;
of factual information.6
clarity, brevity and appropriateness of stem; plausibility of
all distracters and decision of the correct choice. It is also Clinical vignettes provide a good basis for questions at both
important to estimate the level of cognition tested by the comprehension and application levels.10 Each item would
item and the expected difficulty level. Construction of the begin with the presenting problem of a patient, followed by
item can be verified by checking if it can be answered by the history, physical findings, results of diagnostic studies,
only reading the stem & lead‐in. initial treatment, subsequent findings, etc. Brief patient
Indian Journal of Community & Family Medicine | Vol. 1 | Issue 02 | Jul-Dec, 2015 68
Kar S S: Basic principles of constructing multiple choice questions
vignettes or laboratory vignettes may be suitable for Basic and facilitate question banking. It provide a numerical
sciences. The overall structure of an item for such vignettes assessmentof item difficulty and item discrimination.
can be depicted by an item template.6 Use of patient and Itemdifficulty is determined from the percentage ofstudents
lab vignettes to assess application of knowledge has who answered each item correctly.Item discrimination
several benefits like enhancing “face validity” of the exam refers to the percentage differencein correct responses
and focussing on important information rather than between two groups of students (generally referring to
trivia. It also helps to identify those examinees who have students in the top 25% and the lower 25%).7
memorized facts, but are unable to use that information
effectively.7,6 CONCLUSION
Solving MCQs with data, diagrams and images require MCQs can be used as a meaningful and effective tool
higher order thinking skills like analysis and synthesis of evaluation in medical education. The quality of
level. Extended Matching items are multiple-choice items MCQ depends on the quality of items on the whole and
organized into sets that use one list of options for all items presence of efficient distractors. Flawed MCQs interfere
in the set. This reduces the chances of recognition effect with assessment process and therefore it is vital to
(as more than one combination of vignette and option develop reliable and valid items must be constructed
exists) and also helps in testing application and problem that are free of such flaws. Significant time, effort and
solving ability. Key feature questions and assertion reason commitment is required to prepare MCQs that are of good
questions are examples of Evaluation type of questions.10 quality, reliable, able to test higher order thinking skills
and consistent with curriculum objectives. It is essential
Item analysis for medical educators to be skilled in effective test item
writing to assess the learner’s knowledge.
Item analysis is a means to ensure quality of MCQs
REFERENCES
1. Singh T, Gupta P, Singh D. Principles of Medical Education. First. 7. Collins J. Education techniques for lifelong learning: writing
New Delhi: Jaypee Brothers. multiple-choice questions for continuing medical education
2. Srinivasa DK, Adkoli BV. Multiple choice questions: how activities and self-assessment modules. Radiogr Rev Publ
to construct and how to evaluate? Indian J Pediatr. 1989 Radiol Soc N Am Inc. 2006 Apr;26(2):543–51.
Feb;56(1):69–74. 8. Haladyna TM, Downing SM, Rodriguez MC. A Review of Multiple-
3. Al-Rukban MO. Guidelines for the construction of multiple Choice Item-Writing Guidelines for Classroom Assessment.
choice questions tests. J Fam Community Med. 2006;13(3):125– Appl Meas Educ. 2002 Jul 1;15(3):309–33.
33. 9. Ananthakrishnan N, Sethuraman K, Kumar S. Medical
4. Brady A-M. Assessment of learning with multiple-choice Education: Principles and practice. Second. Pondicherry:
questions. Nurse Educ Pract. 2005 Jul;5(4):238–42. Alumni association of National Teacher Training Centre,
5. Singh T, Natu MV. Examination reform at the grassroots: teacher JIPMER, Pondicherry;
as the change agent. Indian Pediatr. 1997 Nov;34(11):1015–9. 10. Singh T, Anshu. Principles of assessment in Medical Education.
6. Case S, Swanson D. Constructing Written Test Questions For First. New Delhi: Jaypee Brothers.
the Basic and Clinical Sciences [Internet]. National Board of 11. Lowe D. Set a multiple choice question (MCQ) examination.
Medical Examiners, Philadelphia; Available from: http://www. BMJ. 1991 Mar 30;302(6779):780–2.
nbme.org/pdf/itemwriting_2003/2003iwgwhole.pdf
Indian Journal of Community & Family Medicine | Vol. 1 | Issue 02 | Jul-Dec, 2015 69