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C o n t e n t s

Multiple choice questions: characteristics 49

Multiple true/ false type 50

Basic structure for One best type 52

Basic rules for one best items 53

Steps in writing one best type MCQs 55

T e m p l a t e f o r o n e b e s t i t e m s : 1st stage 57

T e m p l a t e f o r o n e b e s t i t e m s : 2nd stage 58

Guide to writing one best items for basic sciences 65

Extended matching example 66

Writing extended matching: procedure 67

Writing the item stems 70

Frequently asked questions 71

Templates for extended matching questions 74

ASSESSMENT OF COMPETENCE

S C H E D U L E

DAY TWO

Multiple choice questions: characteristics

Multiple true/ false type

Basic structure for One best type

Basic rules for one best items

Writing one best type MCQs

Extended matching

Writing extended matching: procedure

Critique

MULTIPLE CHOICE QUESTIONS CHARACTERISTICS

1. FEASIBILITY: Difficult to make and easy to mark.

2. OBJECTIVITY: High because everyone marks them exactly the same.Key is pre-determined.

3. RELIABILITY: High. It depends on number of questions, number ofstudents and the quality of MCQs. If all these are optimum, thenreliability comes out to be very high.

4. FACE VALIDITY: Moderate to High. ( it does seem that you areexamining medical students and testing their cognitive abilities)

5. CONTENT VALIDITY: High. This is because of the possibility ofincreased sampling (of topics) within a given test time.

6. CONSTRUCT VALIDITY: High. It is possible to assess recall,interpretation and problem solving by MCQs easily. Since MCQs wellassess these ‘constructs’ (i.e. characteristics), their construct validityis high.

7. PREDICTIVE VALIDITY: High. It is possible to predict on the basis ofMCQ results whether a person can demonstrate problem solving orother higher cognitive abilities in the next level. However it is notpossible to predict whether he/ she will be a good doctor in the futurejust on the basis of MCQ results. So one needs to be very careful whatone wants to predict.

8. CONSEQUENCE VALIDITY: High. Students tend to do less selectivestudying when preparing for MCQ exams.

49Assessment of Competence

DAY

TWO

MULTIPLE TRUE/FALSE TYPE An initial statement (called stem) is followed by five completions (calleditems). Each item must be correctly identified as either "TRUE" or "FALSE".

EXAMPLE Instructions:Mark either "T" for TRUE or "F" for FALSE for each item given below, orshade the appropriate box for each correct answer in the response sheetwith the pencil provided to you.

1. Characteristic feature/s of "Cushing’s Syndrome" include:A. generalised obesityB. hypertensionC. menorrhagiaD. proximal muscle weaknessE. osteoporosisKEY : T :B,D,E F :A,C.

(It may be written in this form also) A/F, B/T, C/F, D/T, E

2. ONE BEST TYPEAn initial statement (called question stem) is followed by a statement /question (called lead-in statement/ question). Under this lead-in are fivecompletions (called options). The candidate is required to select the bestoption.

EXAMPLE:Instructions:Choose the BEST ANSWER from the options given below and shadethe appropriate box in the response sheet with the special pencilprovided to you.

1. A man of 68 years presents with a sudden episode of severe colickyabdominal pain. Within three days of admission to hospital, hebecomes jaundiced and develops high-grade fluctuating pyrexia. The most likely diagnosis in this patient is:A. infective hepatitisB. cirrhosis of liverC. a stone impacted in the common bile ductD. carcinoma of the head of pancreasE. an intrahepatic abscess

KEY: C


DAY

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DIFFERENCES BETWEEN MULTIPLE TRUE FALSE AND ONE BEST TYPE MCQs

ONE BEST TYPE● All the items may be correct but one is the most appropriate.● Opportunity of guessing is 1/5(20%)● Can measure a variety of learning objectives from simple to complex

MULTIPLE TRUE/ FALSE TYPE● Every item is absolutely correct or incorrect. ● Opportunity of guessing is (50%)● Can measure relatively simple learning objectives e.g. recall of facts


DAY

TWO

BASIC STRUCTURE OF ONE BEST ITEMSAn item template or basic structure can depict the overall structure of an

item. By following the examples we are providing you with, it will become

very easy for you to construct high quality items. You can typically generate

many items for assessing basic science knowledge by using the same

template.

Different publications tend to use different names for the different parts

of MCQs and this can be quite confusing. This document uses the following

terms:

● The whole of an MCQ is called an item

● The main part of the item (that is, the part that presents the scenario)

is called the question stem

● The part of the item that tells the candidate what he has to do is the

lead-in statement. This could be in the form of a sentence (as in the

example below) or a question.

● The lead-in statement is followed by a list of 5 options from which

candidates have to select the best answer. This is called the option list.


DAY

TWO

A patient is broughtto the emergencydepartment. He isfeeling ill, reports a‘ringing’ in his ears,has a hear rate of90/min and the QRSintervals on his ECGare prolonged. Hesays he is taking a‘heart drug’ but doesnot know what it is.The drug he is mostlikely to be taking is:a) digoxinb) captoprilc) phenytoind) propanolole) quinidine*

( correct answer)

This is the QUESTIONSTEM

This is the LEAD-INSTATEMENT

This is the OPTIONLIST

The QUESTIONSTEM, LEAD-INSTATEMENT andthe OPTION LIST

is the ITEM

BASIC RULES FOR ONE BEST ITEMS

1. EACH ITEM SHOULD FOCUS ON AN IMPORTANT CONCEPT, TYPICALLY

A COMMON ONE:

Don’t waste testing time with questions assessing knowledge of trivial

facts. Focus on problems that would be encountered in real life by the

clinician. Avoid trivial, 'tricky' or overly complex questions.

2. EACH ITEM SHOULD ASSESS APPLICATION OF KNOWLEDGE, NOT

RECALL OF AN ISOLATED FACT:

Clinical scenarios provide a good basis for a question. For clinical

sciences, each should contain the following points:

● Presenting problems

● History (duration of signs and symptoms)

● Relevant physical findings

● Results of diagnostic studies

● Initial treatment

● Subsequent findings Information should be provided in this specified

order.

3. THE QUESTION STEM OF THE ITEM MUST POSE A CLEAR LEAD-IN

QUESTION, AND IT SHOULD BE POSSIBLE TO ARRIVE AT AN ANSWER

WITH THE OPTIONS COVERED:

To determine if the question is focused, cover up the options and see if the

question is clear and if the examinee can pose an answer based only on

the stem. Rewrite the stem and/or options if they could not.

4. AVOID TECHNICAL ITEM FLAWS THAT PROVIDE SPECIAL BENEFIT TO

THE TESTWISE EXAMINEES OR THAT POSE IRRELEVANT DIFFICULTY.

(SEE APPENDIX I)

5. DO NOT WRITE ANY QUESTION OF THE FORM

"Which of the following is correct?" or "Each of the following is correct

EXCEPT".

These questions are unfocused and have heterogeneous options.

6. ALL ITEMS SHOULD REQUIRE APPLICATION OF KNOWLEDGE:This allows assessment of both, an examinees information base plus

ability to use that information.


DAY

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.

7. THE OPTION ON WHICH THE QUESTION STEM IS BASED MUST BE:● Indisputably a better answer than any of the others, even though others

might be partially correct or correct in certain special circumstances.

● Clearly incorrect or inferior to the correct answer

● Plausible and attractive to the uninformed

● Similar to the correct answer in construction and length.

● Grammatically consistent and logically compatible with the stem

EXAMPLE FROM CLINICAL SCIENCESA man of 68 years presents with a sudden episode of severe colicky

abdominal pain. Within three days of admission to hospital, he becomes

jaundiced and develops high-grade fluctuating pyrexia. The most likely

diagnosis in this patient is:

A. infective hepatitis

B. cirrhosis of liver

C. a stone impacted in the common bile duct

D. carcinoma of the head of pancreas

E. an intrahepatic abscess

KEY : C


DAY

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DAY

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STEPS IN WRITING ONE BEST TYPE MCQs

The problem that almost all untrained item-writers run into is that theyinstinctively (and incorrectly) start in the wrong place! They tend to think ofthe question stem first and then the option list. It is MUCH easier to writethe options first.

The following steps are suggested:

1. Work in small teams of 3 or 4 people. These may be teams from withinthe same discipline or they may be multi-disciplinary teams. (For College examinations, teams from the same discipline might beeasiest at first, but a multi-disciplinary approach is more recommended).

2. Brainstorm in order to produce a list of possible topics/ themes to write items about (e.g. Abdominal pain, Anaemia, Back pain, Chestpain, Dizziness, Fatigue, Fever etc).

3. Select one topic from the list. Write the selected theme and sub-themeon the 1st stage form that we have provided.

4. Generate a list of possible options, based on the selected topic. It isusually a good idea if this list is of more than 5 options (although onlywill be used in the final item). This allows a couple of ‘spares’, whichoften comes in handy! It is important that this list is HOMOLOGOUS (i.e. all diagnoses, therapeutics, lab investigations, complications etc).

5. Select ONE of the options.

6. Write a question stem & lead-in statement based on this one option.

7. Ignore all other options temporarily.

8. Make sure that the question stem is reasonably short (a few lines long– see the example above) but contains all the relevant information forthe candidate to reach the correct answer.

9. Reduce the option list to 5 (including, of course, the correct answer).

10. Arrange the option list into a logical order (e.g. alphabetic, numeric).

11. Check your work: When your group is satisfied with its work so far, ifpossible pass the QUESTION STEM (but NOT the option list) to anothergroup. The other group should be able to reach the same answer asthat intended from the option list. If they have a problem in doing this,then the item probably needs some additional work.

12. If the other group is unable to guess the correct answer then you willhave to re-consider the options and the question stem that you havemade. Maybe it needs to be made simpler.

13. Repeat step number 11. (That means show it to another group again!)

14. Once you have finalized the please, transfer the item to the 2nd stageform. Make sure that you mention th/e level of importance and estimate of difficulty in this form.

15. Staple both the forms

16. Mail them to : DIRECTOR MCQ BANK CPSP, 7TH CENTRAL STREET,DHA PHASE V, KARACHI 75500.


DAY

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One Best Item - 1st StageWriter(s)___________________________________ Date____/____/___

Specialty________________Sub-Speciality_______________________

= Choose a theme (eg fatigue, antibiotics, enzymes, diet, cardiacarrhythmias) and sub-theme (eg diagnosis, laboratoryinvestigations, therapy):

Theme: _________________Sub-Theme_________________________(e.g. a presenting complaint)

== Make a list of 6 to 10 options (the provisional option list). Thesewill later form the branches of the question. They must behomologous (eg all diagnoses, antibiotics, blood gas values etc) andeach should be short normally only one or two words)

Provisional option list:More than 5 are needed- the list must be short and homologous1 6

2 7

3 8

4 9

5 10

== Now select ONE of the provisional options and mark it with an asterisk.== Write a vignette (case scenario) that suits the selected option, to form

the question stem. This should normally be between two and fivesentences in length.

Question stem:

== Next, look at the other options in the provisional list and cross out anythat also suit the selected option well.

== Finally, reduce the option list to 5, containing the selected option plus 4others. The chosen option MUST be an indisputably better answer thanthe other 4 (although the other 4 do not have to be totally- incorrect).


DAY

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One Best Item - 2nd StageWriter(s)___________________________________ Date____/____/___


Theme: _________________Sub-Theme_________________________

= Set out the 5 selected options from the 1st stage, arranged ina2logicalorder ( eg alphabetical, numerical) to form the item branches.

Option list (branches)

a)

b)

c)

d)

e)

= Identify the secret response in the option list with an asterisk. = Now write out the question stem

Question stem:-

== Please indicate the importance of the material being tested in this item,and also estimate how difficult you think the item is:.

Importance: Essential / Important / Supplementary

Estimate of Difficulty: Hard / Moderate / Easy


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2 7

3 8

4 9

5 10



Question stem:




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Theme: _________________Sub-Theme_________________________



a)

b)

c)

d)

e)


Question stem:-





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2 7

3 8

4 9

5 10



Question stem:




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Theme: _________________Sub-Theme_________________________



a)

b)

c)

d)

e)


Question stem:-





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2 7

3 8

4 9

5 10



Question stem:




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Theme: _________________Sub-Theme_________________________



a)

b)

c)

d)

e)


Question stem:-




GUIDE TO WRITING ONE BEST ITEMS FOR BASICSCIENCES

Traditionally, items are classified by the cognitive processes required to

answer the question (e.g., recall, interpretation, or problem solving;

memory, comprehension, or reasoning). Recall items are thought to test

examinees’ knowledge of isolated facts.

A simpler, more objective approach bases item classification on the task

of the examinee. If an item requires an examinee to reach a conclusion,

make a prediction, or select a course of action, it should be classified as

an application of knowledge item. If an item tests only rote memory for

isolated facts (without requiring their application), it should be classified as

a recall item. All items should require application of knowledge, allowing

assessment of both an examinee’s information base plus ability to use

that information.

The following pair of items illustrates the difference between a question

assessing recall of an isolated fact and a question assessing application

of knowledge.

APPENDIX ISummary of Technical Item FlawsIssues Related to Testwiseness● Grammatical cues - one or more options don’t follow grammatically from

the stem● Logical cues - a subset of the options is much longer than the other or

much shorter● Absolute terms - terms such as "always" or "never" are in some options● Long correct answer - correct answer is longer, more specific, or more

complete than other options● Word repeats - a word or phrase is included in the stem and in the

correct answer● Convergence strategy - the correct answer includes the most elements

in common with the other options Issues Related to Irrelevant Difficulty● Options are long, complicated, or double● Numeric data are not stated consistently● Terms in the options are vague (eg, "rarely," "usually")● Language in the options is not parallel● Options are in an illogical order● Stems are tricky or unnecessarily complicated● The answer to an item is "hinged" to the answer of a related item

And most important of all: Focus on important concepts; don’t wastetime testing trivial facts.


DAY

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EXTENDED MATCHINGEXAMPLE

Theme: Fatigue. Sub-theme: diagnosis

Lead-In: For each patient with fatigue, select the most likely diagnosis.

Options:

Item Stems:1. A 19 year old woman has had fatgue, fever, and sore throat for the

past week. She has a temperature of 38.3oC ( 101F), cervical lymphadenopathy and splenomegaly. Initial laboratory studies show aleukocyte count of 5000/mm3 ( 80% lymphocytes with many lymphocytes exhibiting atypical features), serum aspartate aminotransferase ( AST, GOT) activity is 200U/L. Serum bilirubin concentration and serum alkaline phosphatase activity are within normal limits.

2. A 15 year old boy has a two week history of fatigue and back pain. He has widespread bruising, pallor and tenderness over the vertebraeand both femurs. Complete blood count shows hemoglobinconcentration of 7.0 g/dl, leukocyte count of 2000/mm3, and plateletcount of 15,000/mm3.

KEY: 1. E2. A.


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A. Arteries.B. Nerves.C. Muscles.D. Amino acids.E. Hormones.F. Cell components.G. Blood components.H. Molecules.I. pathogensJ. Toxins.K. Vitamins/ minerals.L. Diagnoses.M. Endocrine structures.

N. Immune disorders.O. CNS components.P. Drugs.Q. Main presenting complaints.R. initial management steps.S. side effects of drugs.T. electrolyte abnormalities.U. most crucial investigation.V. management alternatives.W. neurotransmitters.X. cytokines.Y. secretory products.Z. causative agents.

WRITING EXTENDED MATCHINGPROCEDURE

1. Identify the theme and sub theme for the set of options.

2. Write the lead-in for the set. The lead-in indicates the relationship

between the stem and options, clarifying the question posed for the

examinees. It is an essential component of extended matching set.

Following is an example of a typical lead-in: “For reach of the following

cases of dyspnea, select the most appropriate investigation:”

3. Prepare the list of options based on the sub theme.

4. Select 2 or 3 options from the list. these become your key.

5. Write the items stems revolving around the selected key. These

contain patient vignettes. It is also possible to give lab data. For the

sake of better sampling of content,it is proposed that more than one

scenario be written per option list.

GUIDELINES FOR OPTION LIST:

● By research, it has been found that an optimum number of option list is

around 18.

● The list of options should be single words or very short phrases.

● They must be homogenous ( all diagnoses, all management options

etc.). Don’t use uncommon diagnoses or subtle distinctions.

● List the options in alphabetical order unless there is a logical order.

DIFFERENCE BETWEEN THEME AND TOPIC

A theme is a broad area and is usually based on symptoms that patients

present with. For example, polyuria is a symptom and maybe designated

as a theme since it maybe caused by conditions other than Diabetes

Mellitus also. Contrary to this, topics are issues based on how the

discipline is divided. It is usually according to site of disease or body

systems, e.g. diseases of lower GIT. Infections of neonates, gram positive

bacteria, labour, Diabetes Mellitus etc.

So, the general rule of the thumb is:

If it is the name of a disease/ condition it is a topic.

If it is a symptom (that may have a variety of underlying causes, then it is

a theme.


DAY

TWO

List of Possible Themes:Abdominal mass dizziness lymphadenopathy melena

Abdominal pain easy bruising movement abnormalities

Anemia fatigue nausea

Ascites fever palpitations

Back pain GI bleeding sexual dysfunction

Chest pain headache shortness of breath

Confusion hematemesis skin lesion

Cough itching syncope

Developmental delay jaundice weight change

Diarrhea joint pain wheezing

GUIDELINES FOR WRITING LEAD-INS ● Lead-ins generally begin with a phrase such as " For each of the

following patients".● Often sets are organized around chief complaints or some other factor

that allows a more specific introductory phrase such as " For each ofthe following patients with fatigue…." Or " For each of the followingpatients with an enzyme deficiency…..".

● The second part of the lead-in describes the task and the option set: "select the most likely diagnosis"; " select the protein that is most likelyto be defective."

The following are some additional sample lead-ins and some suggested

topics for option lists:

= For each of the following patients, select the ( e.g. nerve) that is most

likely to be ( abnormal/ defective/ deficient/ nonfunctioning).

= Option sets could include list of nerves; list of muscles; list of enzymes;

list of hormones; list of proteins; list of types of cells; list of

neurotransmitters; list of pathologic processes.

= For each of the following patients, select the (finding) that would be

expected:

= Option sets could include list of lab results; list of additional physical

signs; autopsy results; list of microscopic examination of fluids,

muscles or joint tissue; DNA analysis results; hormone levels.

= For each of the following patients, select the most likely ( cause):

= Option sets could include list of underlying mechanisms of disease;

medications that might cause side effects; drugs or drug classes; toxic

agents; hemodynamic mechanisms, viruses, metabolic defects.


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= For each of the following patients, select the (drug) that should be

administered.

= Options sets could include list of drugs, vitamins, amino acids,

enzymes, hormones.

= For each of the following patients, select the most likely diagnosis.

= Options sets could include list of diagnoses, most often organized

around a chief complaint such as diseases that cause chest pain or

diseases that cause fever.

= For each of the following patients, select the most appropriate next step

in patient care.

= Options sets could include list of pharmacologic therapies, list of lab

studies, disposition alternatives, or the options could include a mixed

set of treatments and additional studies to assess whether the student

knows when sufficient data have been gathered.


DAY

TWO

WRITING THE ITEM STEMS= Patient vignettes or clinical scenarios provide an excellent structure for

item stems.

= The vignette commonly provides the following information, though all of

it does not have to be present in one item set:

Age,

Gender,

Chief complaint,

Site of care,

Personal history,

Physical examination information,

Lab data.

Items to assess knowledge of basic sciences, particularly for courses

taught in the first or second professional years might include less

detailed descriptions.

= Each patient, the description should be similar in format to the others

in the set. For example, if lab data is included in one item then it should

be included in all the items.

= It is advisable not to mix adult and paediatric cases in the same set.

= The items should be straightforward.

= There is no reason to make them tricky; the extended option list makes

them difficult enough to allow you to distinguish the knowledgeable

student from the other students without resorting to trickery.

= Use the ' cover-the-option' rule that you used in the construction of one

best type.

Review the items:

● Check to make sure there is only a single best answer for each

question.

● Also make sure that there are at least four reasonable distractors for

each item.

● As a final check, it is recommended that you ask a colleague to review

the items without the correct answers indicated.

● If the colleague has difficulty in determining the correct answer, modify

the option list or item to eliminate the ambiguity.


DAY

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FREQUENTLY ASKED QUESTIONS

Why is CPSP changing to One-Best and Extended Matching Questions(EMQs)?Because they have been proven internationally to have a great ability totest higher cognitive processes and have a high degree of reliability.Internationally there is a lot of interest and work being done on EMQs andone best. USMLE already have mastered it… and the British are gettingtrained in it and are seriously considering introducing it in their Fellowshipand Membership exams.

Why do we need to do themes and sub themes?

As mentioned above, themes are usually symptoms. It is important for a

consultant to recognize symptoms and work onwards from there since that

is how he will encounter patients. If he is able to deal with problems on

paper based on how people will present to him, then it is safe to assume

that he will use the same mental process in real life also. Sub themes are

kept to focus the thoughts of the person making the MCQ and the person

attempting it towards a particular aspect of the theme. For example, if

polyuria were a theme, then the sub theme could be diagnosis (of polyuria)

for which the option list of diseases would be present. The sub theme may

also be investigations (of polyuria), for which the option list would contain

a list of investigations, all of which would be relevant to cases of polyuria.

Can you provide me with more examples of topics, themes and sub themes?Consider the following topics and related themes:

Topic Theme Sub themeAcute abdomen pain in Right investigations

hypochondrium

Upper respiratory Diseases cough drugs

Compoud fractures bleeding investigations

Pre-operative next step inAssessment weakness management


DAY

TWO

What do we need to be careful about regarding critique of MCQs?Ensure that:a. The section of ‘theme’ ( and sub theme) does not have topics.b. The options are homologous (all diagnoses, all drugs, all investigations

etc.)

c. There are no illogical options that do not fit the theme or the sub theme.There might be a few that are easy to guess or maybe easy to exclude.However, if they are according to the theme and sub theme (as requiredin One best) then they may be retained.

d. Those options are deleted that are too close to the key. The concept isto discriminate the average students from the below average ones andnot to confuse them.

e. The item writers have marked about the difficulty and importance of theMCQ. So they must write at the end of an MCQ (both One Best and EMQ)whether it is hard, moderate or easy and whether it is essential,important or supplementary information that is asked.

f. The options are in logical order. Usually they should be in alphabetcialorder. Order is especially important where numbers are in the options.

For example, the following is an example of a bad option list:A. 10 mg/ dlB. 102 mg / dlC. 50 mg / dlD. 33 mg / dlE. 75 mg / dl

This can be improved to:A. 10 B. 30C. 50D. 70E. 90

The good points about the above option list are that it:1. is in ascending order2. the gap between the numbers is equal3. there is no repetition of mg/ dl. The units should be in the top one

option or part of the lead-in statement.


DAY

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How do we decide whether this question is hard or easy or essential orsupplementary?Considering the fact that you are assessing a to-be-consultant, you are thebest judge about how difficult an item is for the AVERAGE candidate.Always think in terms of the average student.

In order to decide about the importance, just think whether the informationbeing asked is so important that a person has no right to be a consultantif he does not know this. If such is the case then that item should belabeled essential. If you think an item is asking information aboutsomething that is very important for an average student (but a little less inimportance than the essential one) then it should be labeled as important.If there is an item that is asking about something that only the topstudents should know or that is not important for an average student toknow in order to be a safe consultant. Then it should be labeled assupplementary.


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DAY

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COLLEGE OF PHYSICIANS ANDSURGEONS PAKISTAN

EXTENDED MATCHING QUESTION

Writer(s)___________________________________ Date____/____/___


Theme: ___________________________________________________(e.g. a presenting complaint)

Sub-theme_________________________________________________(e.g. diagnosis, laboratory investigations, therapy)

Lead -In:___________________________________________________

(Sample Lead – in: For each patient with ________ (theme), select the

most likely ________ (sub-theme)

Options:

A N

B O

C P

D Q

E R

F S

G T

H U

I V

J W

K X

L Y

M Z


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Item stem: (write atleast two scenarios for each option list)Scenario 1:

Scenario 2:

Key for Scenario 1: _________


Please indicate the importance and difficulty levels of the material beingtested in this item:

Importance: Essential/Important/SupplementaryEstimate of difficulty: Hard/Moderate/Easy


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Writer(s)___________________________________ Date____/____/___




Lead -In:___________________________________________________



Options:

A N

B O

C P

D Q

E R

F S

G T

H U

I V

J W

K X

L Y

M Z

Item stem: (write atleast two scenarios for each option list)Scenario 1:

Scenario 2:






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Writer(s)___________________________________ Date____/____/___




Lead -In:___________________________________________________



Options:

A N

B O

C P

D Q

E R

F S

G T

H U

I V

J W

K X

L Y

M Z


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Item stem: (write atleast two scenarios for each option list)

Scenario 1:

Scenario 2:






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Writer(s)___________________________________ Date____/____/___




Lead -In:___________________________________________________



Options:

A N

B O

C P

D Q

E R

F S

G T

H U

I V

J W

K X

L Y

M Z


DAY

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Item stem: (write atleast two scenarios for each option list)

Scenario 1:

Scenario 2:





SCHOOL»S BACK IN SESSIONA high school teacher was giving a true/false test. He was strolling up and

down the aisles surveying the students at work. He came upon one

student who was flipping a coin, the writing.

Teacher: What are you doing?

Student: Getting the answers to the test.

The teacher shook his head and walked on. A little while later, when

everyone was finished with the test, the teacher noticed the student was

again flipping the coin.

Teacher: Now what are you doing?

Student: I’m checking the answers.


DAY

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