Transcript Formatting Answers

Formatting the Answers:
Avoiding Common Errors
ABCRS Question Writing Workshop
Glenn T. Ault, MD, MSEd
Associate Professor of Surgery -Program Director –Colorectal Residency
Senior Associate Dean, Clinical Administration (LAC+USC)- Univ. of Southern California
1
• No disclosures
Parts of the Answers:
• Options – all choices provided after the stem
(includes the key and the distractors)
• The Key – the correct answer in the list of
options
• The Distractors – the incorrect answers in the
list of options
Which of the following is a manifestation of adrenal insufficiency?
A. Hypertension
B. Hypokalemia
C. Hypothermia
D. Tachycardia
Writing the Options
• Well written stem is important
• Start with the key
• There should be one and only one correct
answer or clearly the best answer on which
experts would agree.
Writing Options - Distractors
• Generally more difficult than writing the stem
• Strategically designed to attract examinees
who haven’t completely mastered the content
and skill
• Plausible options
• Incorporate common misunderstandings or errors
• Make length of options similar (biased cueing)
Writing Options - Distractors
• Avoid negatives and/or double negatives
• Avoid “The Absolutes” - words as always, never
and all
• Avoid highlighting any options with quotation
marks or parenthesis
• Avoid vague frequency terms – sometimes, often,
seldom, usually, frequently, likely
• No longer use format of questions that includes
“all of the above”, “both a and c above”, or “none
of the above”
Distractors – Common Flaws
Overlapping Alternatives
During which age period is thumbsucking likely to produce the greatest
psychological trauma?
During which age period is thumbsucking likely to produce the greatest
psychological trauma?
A.
B.
C.
D.
A.
B.
C.
D.
Infancy
Preschool period
Before adolescence
During adolescence
From birth to 2 years old
From 2 to 5 years old
From 5 to 12 years old
From 12 to 20 years old
Distractors – Common Flaws
“Grammatical Clues”
Albert Einstein was a:
Who was Albert Einstein?
A.
B.
C.
D.
A.
B.
C.
D.
Anthropologist
Astronomer
Chemist
Mathmetician
An anthropologist
An astronomer
A chemist
A mathmetician
Distractors – Common Flaws
“Grammatical Clues”
A 60-year-old man is brought to the emergency department after being found
unconscious on the sidewalk. After verifying that the airway is open, the next
step should be the IV administration of
A.
B.
C.
D.
phenytoin
diazepam
Glucose with Vitamin B1
Tylenol
Distractors- Common Flaws
“Clanging”
• A word or phrase that is in the stem also
appears in the correct answer
A 58-year-old with a history of heavy alcohol use and previous
psychiatric hospitalization is confused and agitated. He speaks of
experiencing the world as unreal. This symptom is called
A. Depersonalization
B. Derailment
C. Derealization
D. Signal anxiety
Distractors- Common Flaws
“Non-parallel Structure”
• The options list three diagnostic studies and
one method of treatment
• Test wise examinee will discard treatment and
focus on diagnostics
• If treatment options used – escalate options
from observation – medical management to
surgery/ or least invasive to more invasive
Examples – Non-parallel Structure
A 29-year old pregnant patient
presents with right lower quadrant
pain. What is the next best step?
A 29-year old pregnant patient
presents with right lower quadrant
pain. What is the next best step?
A.
B.
C.
D.
A.
B.
C.
D.
MRI
CT-scan
Ultrasound
Laparoscopy
KUB
Ultrasound
CT-scan
MRI
Options – Common Flaws
Answer is the longest option (Bias Cueing)
• We as authors tend to make the key longer
because we want to include more detail, more
information
• Fall into this trap because we want to qualify
the answer to make it “completely” correct
All answers should be similar in length to avoid
this flaw…
Example –Bias Clueing
Which of the following is a
consequence of secondary gain?
Which of the following is a
consequence of secondary gain?
A. Previously unreported physical
symptoms
B. Prolonging of illness associated
with advantages such as
attention, relief from
responsibility, or financial
advantage
C. Obsessive-Compulsive Disorder
D. Organic brain damage
A. Previously unreported physical
symptoms
B. Prolonging of illness
C. Obsessive-compulsive disorder
D. Organic brain damage
Options – Common Flaws
“Logical Clueing”
What property of methadone differentiates it from other
medications classified as narcotic analgesics?
A. Methadone has a longer half-life
B. Methadone has a shorter half-life
C. Methadone is less likely to cause nausea
D. Methadone is a narcotic antagonist
Options – Common Flaws
“Convergence”
• We tend to write the key first and then make
the distractors plausible by making it partially
correct.
What is the total amount of kcal provided by one can of Ensure?
A. 26
B. 150
C. 260
D. 2600
Another example of convergence…
Testing which nerves provides the
most useful information to establish
the diagnosis:
A. Median motor, peroneal motor,
facial, and sural
B. Median motor, peroneal motor,
tibial H reflex, and facial
C. Median motor, ulnar motor,
facial and sural
D. Peroneal motor, tibial motor,
peroneal F wave, and facial
In addition to testing the median
motor, peroneal motor, and facial
nerves, evaluation of which of the
following is likely to be most useful
for establishing the diagnosis?
A.
B.
C.
D.
Sural
Ulnar motor nerve
Tibial H reflex
Peroneal F wave
“Overlapping Numeric Options”
Following a second episode of diverticulitis, what is the
likelihood that another episode will occur?
A. Less than 20%
B. 20 to 30%
C. Greater than 50%
D. 90%
• We should expect examinees to demonstrate their knowledge,
not encourage them to try and game the system through
flawed test items.
“Overlapping Numeric Options”
In a normal adult, what percent of blood volume loss will result
in irreversible organ damage?
A. 10%
B. 20%
C. 30%
D. 40%
• In a normal adult, what is the minimum percent of blood
volume loss that will result in irreversible organ damage?
The “Answers”- Conclusions
• Options:
• Parallel in structure
• Fit logically and grammatically with the stem
• Worded concisely, clear and simple – delete
unnecessary words!
• Inclusive that they logically eliminate another
more restricted option from being a possible
answer
The “Answers”- Conclusions
• The Key:
• Correct and best answer
• Answers the question posed in the stem
• Should not be too obvious relative to the other
alternatives (should be shortened, lengthened,
given greater number of details, made less
concrete)
The “Answers”- Conclusions
• The Distractors:
• Be plausible but should not be justified as an
acceptable correct answer
• Plausible enough to be attractive to examinees
who are misinformed or ill-prepared
• Does not call attention to the key (should not
merely state the reverse of the key, resembles key
too closely, involves opposites)
THANK YOU!
Glenn T. Ault, MD, MSEd
[email protected]