Transcript from Ryan Madanick

@RyanMadanickMD
#UNCAOE
Writing Meaningful Test
Questions
Ryan D. Madanick, MD
Assistant Professor of Medicine
Center for Esophageal Diseases and Swallowing (CEDAS)
Division of Gastroenterology and Hepatology
University of North Carolina School of Medicine
Chapel Hill, NC
Email: [email protected]
Twitter: @RyanMadanickMD
Blog: http://gutcheckblog.com
Phone: (919) 966-2513
Fax: (919) 843-2508
@RyanMadanickMD
#UNCAOE
Learning Objective
By the end of this session, learners should
be able to:
–Create a meaningful 1st order multiple
choice question using an objectivebased process
@RyanMadanickMD
#UNCAOE
Question Components
STEM
LEAD-IN
OPTIONS
@RyanMadanickMD
#UNCAOE
Question Components
ANSWER
OBJECTIVE
EXPLANATION
@RyanMadanickMD
Steps to Writing the MCQ
1.
2.
3.
4.
Determine the objective you are testing
Write the lead-in and options
Draft the stem
Write the explanation (if needed)
#UNCAOE
@RyanMadanickMD
Improving the Educational
Objective
• “Understand peptic ulcer disease”
What is wrong with this objective?
How could it be improved?
#UNCAOE
@RyanMadanickMD
#UNCAOE
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
@RyanMadanickMD
Action Verbs for Objectives
#UNCAOE
@RyanMadanickMD
#UNCAOE
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”
@RyanMadanickMD
#UNCAOE
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
@RyanMadanickMD
#UNCAOE
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
@RyanMadanickMD
#UNCAOE
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)
@RyanMadanickMD
#UNCAOE
EXERCISE
@RyanMadanickMD
#UNCAOE
Write an objective for a potential
test question
@RyanMadanickMD
#UNCAOE
Write the lead-in and options for
your objective
@RyanMadanickMD
#UNCAOE
Draft the stem for your question
@RyanMadanickMD
#UNCAOE
Learning Objective
By the end of this session, learners should
be able to:
–Create a meaningful 1st order multiple
choice question using an objectivebased process
Special thanks to Amy Oxentenko, MD for some of these slides