General instructions

Item type appropriate for measuring the intended learning outcome

Item task matches the intended learning outcome

Focus on an important concept in real life, common disease or potentially serious problem

Checks application of knowledge, not recall facts

Item construction

Stem

 Presents a single, clearly formulated problem

Stated in simple clear language & not be tricky or overtly complex

Preferably be a clinical scenario

Also….

1. Mention age, gender, occupation of patient
2. Begin with presenting problem
3. Followed by history with durations
4. Followed by physical findings
5. Followed by results of diagnostic tests
6. Followed by initial treatment

Additional tips

1. Information may be limited but the sequence should remain the same
2. Size between 30 to 60 words
3. Can be answered even without looking at the option list
4. Use present tense
5. No unnecessary information.
6. Avoid terms “may be”, “always”
7. Avoid repeated use of words
8. Avoid negatively phrased sentences

Options

(Key & distractors)

Is the intended answer correct or clearly best?          

Are all alternatives grammatically and logically consistent with the stem?

Are the alternatives free from verbal clues to the correct answer?

Are the distractors plausible?

Are the options (including the key) of the same length?

Has the alternative “all of the above” and “none of the above” been avoided?

Does the item format and grammar usage provide for efficient test taking?

Are the options homogenous? Same category e.g. diagnostics, management, prognosis etc

Are the numerical values in descending or ascending order