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#UNCAOE@RyanMadanickMD
Email: [email protected]: @RyanMadanickMDBlog: http://gutcheckblog.com
Phone: (919) 966-2513Fax: (919) 843-2508
Ryan D. Madanick, MDAssistant Professor of Medicine
Center for Esophageal Diseases and Swallowing (CEDAS)Division of Gastroenterology and Hepatology
University of North Carolina School of MedicineChapel Hill, NC
Writing Meaningful Test Questions
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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 objective-based process
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Question Components
STEM
OPTIONS
LEAD-IN
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Question Components
OBJECTIVE
EXPLANATION
ANSWER
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Steps to Writing the MCQ
1. Determine the objective you are testing2. Write the lead-in and options3. Draft the stem4. 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 objective-based process
Special thanks to Amy Oxentenko, MD for some of these slides