Guidelines for
preparing Multiple
Choice Questions
(MCQ’s) for PBL Tutors
Student Assessment Committee
Undergraduate Program
Why write a Question?
Recognizes a role for tutors
Recognizes the importance of Assessments
Focuses tutors on the Learning Objectives
Emphasizes application of knowledge and the
Problem Solving Process
Contribution to the Item Bank is documented for
inclusion in Teaching Dossier
Contributors names are submitted for a ‘Prize’ draw
How?
References available:

Case and Swanson, NBME “Constructing
Questions for the Basic and Clinical Sciences”


www.nbme.org; publications, item writing manual
Royal College of Physicians and Surgeons of
Canada website

rcpsc.medical.org- publications and documents-material
for examiners
How?
One-Best Answer Item


Composed of a “stem’ and generally 5
“distractors”, one of which is the correct response
Acute intermittent porphyria is the result of a
defect in the biosynthetic pathway for:





A. collagen
B. corticosteroid
C. fatty acid
D. glucose
E. heme
How to do it better?
A better question is one that uses a clinical
case vignette as the stem:

An otherwise healthy 33 year-old man has mild weakness
and occasional episodes of steady, severe abdominal pain
with some cramping and no diarrhea. One aunt and a cousin
have had similar episodes. During an episode, his abdomen
is distended, and bowel sounds are decreased. Neurological
examination shows mild weakness in the upper arms. These
findings suggest a defect in the biosynthetic pathway for
 A. collagen
 B. corticosteroid
 C. fatty acid
 D. glucose
 E. heme
Good MCQ’s *
Assess application of knowledge
Present a homogeneous set of options
The Basic Rules for
One-Best-Answer Items
1. Each item should focus on an
important concept
Common, serious or potentially
catastrophic clinical problem
 Avoid :

Tricky
 Trivial
 Overly complex

Case and Swanson, 2001
The Basic Rules for
One-Best-Answer Items
2. Each item should assess the
application of knowledge NOT recall
of an isolated fact
Clinical case vignettes provide a good
basis for a question
 Stems may be longer
 Options should be short

Case and Swanson, 2001
Application of knowledge
vs. Isolated Fact
What area is supplied with blood by the
posterior inferior cerebellar artery?
A 63-year old man develops left-sided limb
ataxia, Horner’s syndrome, nystagmus, and
loss of appreciation of facial pain and
temperature sensations. What artery is most
likely to be occluded?
Case and Swanson, 2001
The Basic Rules for
One-Best-Answer Items
3. The stem of the item must pose a
clear question

It should be possible to arrive at an answer
with the options covered
Case and Swanson, 2001
The Basic Rules for
One-Best-Answer Items
4. All distractors (incorrect options)
should be homogeneous

Correct and incorrect options should fall
into the same category (all diagnoses,
tests, treatments, etc)
Case and Swanson, 2001
Distractors
Should be:
Plausible
 Grammatically consistent
 Logically compatible
 Same relative length as the correct answer

Order the options in logical order
(numeric) or alphabetical
Case and Swanson, 2001
The Basic Rules for
One-Best-Answer Items
5. Avoid “technical item flaws” that
provide special benefit to test-wise
examinees or that pose irrelevant
difficulty
Case and Swanson, 2001
Example
Technical Item Flaws
In patients with advance dementia,
Alzheimer’s type, the memory defect





A. can be treated adequately with
phosphatidylcholine (lecithin)
B. could be a sequela of early parkinsonism
C. is never seen in patients with neurofibrillary
tangles at autopsy
D. is never severe
E. possibly involves the cholinergic system
Possible changes
In patients with advance dementia,
Alzheimer’s type, the memory defect
can be effectively treated with
A. cholinergic agonists
 B. dopaminergic agonists
 C. GABA agonists
 D. nicotinic agonists
 E. serotonergic agonists

The Basic Rules for
One-Best-Answer Items
Subject each question you write to the
above 5 “tests”
If a question passes all 5, it is probably
well-written and focused
Case and Swanson, 2001
What?
Each tutor is asked to construct at least
two questions during the block.
Each question will be based on one of
the weekly case objectives
Where?
Please e-mail or provide a paper copy of your
questions prior noon of the last Friday of the
block to:

this presenter;

jenas@interchange.ubc.ca

fairholm@interchange.ubc.ca

detches@cw.bc.ca

eling@cw.bc.ca

hnadel@cw.bc.ca
Final Check?
Please remember to include:



The learning objective the question is testing
The case scenario
The answer to the question
If you can only write 2 – or only parts of the
question - that is OK. Your questions will be
reviewed with feedback to you before
submission to the examination.