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Multiple Choice QuestionMCQ
Dr. Majed WadiMBChB, MSc Med Edu
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Objectives
• To know basic concepts and rationale of MCQ
• To know different types of MCQ• To illustrate anatomy of each type• To discuss guidelines construction of
MCQ • To construct good SBA and EMQ
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Background
Does
Shows how
Knows how
Knows
Written formatsMCQ, MTF, EMQ
Essays
OSCE
Observational instrument
1919 - 1998
Miller pyramid (19900
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Written assessment
Constructed-response formats• Essays questions
Selected-response formats• MCQ
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MCQ
• It was invented in 1914 by Frederick Kelly • It is the most widely used format in
medical and health professional education
• It tests a wide proportion of knowledge
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Strengths of MCQ
• Broad representative content• Effective: contributes to high validity and
reliability per hour of testing time• Objective: contributes to reliability• Defensibility• Accurate, timely feedback• Secure reuse of banked items• Cost-effective: administration and scoring• Higher-order thinking skills measureable if
properly formatted
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Weakness of MCQ• Resource-intensive: requires skill and time to write,
especially context-rich questions• Often used to test recall of facts; trivialization• Promotes surface learning in students if used to test
primarily recall• Promotes trivialization and avoidance of important areas and
cognitive skills among item-writers if faced with difficulty in writing
• Not able to assess summarizing and writing skills, critical thinking processes
• Bad public relations– Guessing– Memorable
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Types of MCQ
Multiple True False (MTF) (X-type MCQ)
Single Best Answer (SBA) (A-type MCQ)
Extended Matching Question (EMQ)(R-type MCQ)
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Anatomy of MCQ
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General terms in MCQ Anatomy• Stem (item)
– The main idea or content you want to test
• Lead in question– To direct examinee toward selection
– It is usually combined to stem
• Options (alternatives)– Statements related to the stem
• Key answer– The correct option
• Distractors– The wrong options
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SBA (A-type MCQ) Anatomy
• Stem (item)– The main idea or content you want to test
• Lead in question– To direct examinee toward selection
• Options (alternatives)– Statements related to the stem
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Example A man of 68 presents with a sudden episode of severe colicky abdominal pain. Within three days of admission to hospital he becomes jaundiced and develops a high fluctuating pyrexia. What is the most likely diagnosis in this patient?
A. Infective hepatitisB. Cirrhosis of the liverC. A stone impacted in the common bile ductD. Carcinoma of the head of pancreasE. An intrahepaticabscess
Stem
Lead-in Question
Options
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MTF (X-type MCQ) Anatomy
• Direction (description or notification)
• Stem
• Lead-in question (accordingly)
• Options
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Example of MTF
Answer by True or False
Which of the following is/are X-linked recessive conditions?a) Hemophilia A (classic hemophilia)b) Cystic fibrosisc) Duchenne’s muscular dystrophyd) Tay-Sachs disease
Stem and Lead-in
question
Options
Direction
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EMQ (R-type EMQ) Anatomy
• It is like SBA in upside down structure
Theme
Options
Lead-in question
Stems (items)
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Example of EMQ
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New trends in MCQ
• MTF is abandoned by NBME (not recommended for use)
• MTF was discouraged by most authorities
• SBA and EMQ are widely used
• They must design to in a good way to test higher level of thinking and application of knowledge
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Guidelines to design good MCQ
1. Content2. Format3. Style4. Stem5. Options
(Haladyna, Downing, & Rodriquez, 2002 )
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Guidelines to design good MCQ
1. Content2. Format3. Style4. Stem5. Options
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Content guidelines1. It must reflect specific content and focus on key
concepts and principles that are essential for candidates
2. Base each item on important content, test material relevant for future career; avoid trivial content.
3. Use novel material to test higher level learning. 4. Keep the content of each item independent.5. Avoid opinion-based items.6. Avoid trick items.7. Keep vocabulary simple and appropriate for the
examinees tested.
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Example of tricky item
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Guidelines to design good MCQ
1. Content2. Format3. Style4. Stem5. Options
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Format guidelines
1. Use the question, completion, and best answer versions of conventional MC, the alternate choice, true-false, multiple true-false, matching, and the context-dependent item and item set formats, but avoid the complex MC format.
2. Format the item vertically, not horizontally.
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Guidelines to design good MCQ
1. Content2. Format3. Style4. Stem5. Options
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Style guidelines
1. Edit and proof items.2. Use correct grammar, punctuation,
capitalization, and spelling.3. Minimize the amount of reading in each
item.
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Appropriate shaped item
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Poorly shaped item
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Guidelines to design good MCQ
1. Content2. Format3. Style4. Stem5. Options
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Stem guidelines
1. Ensure that the directions in the stem are very clear.
2. Include the central idea in the stem, not in the options.
3. Avoid window dressing (excessive verbiage).4. Word the stem positively, avoid negatives such
as NOT or EXCEPT. If negative words are used, use the word cautiously and always ensure that the word appears capitalized and in bold type.
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Guidelines to design good MCQ
1. Content2. Format3. Style4. Stem5. Options
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Options guidelines1. Develop as many effective choices as you can, but
research suggests three is adequate.2. Make sure that only one of these choices is the right
answer.3. Vary the location of the right answer according to the
number of choices.4. Balance the answer key, insofar as possible, so that the
correct answer appears an equal number of times in each answer position.
5. Place the choices in logical or numerical order.6. Keep choices independent; choices should not be
overlapping in meaning.
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Options guidelines cont’
7. Keep choices homogeneous in content and grammatical structure.
8. Keep the length of choices about equal.9. None-of-the above should be used
carefully.10. Avoid All-of-the-above.11.Phrase choices positively; avoid
negatives such as NOT.
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Options guidelines12. Avoid giving clues to the right answer, such as:
a. Specific determiners including always, never, completely, and absolutely.
b. Clang associations, choices identical to or resembling words in the stem.
c. Grammatical inconsistencies that cue the test-taker to the correct choice.
d. Conspicuous correct choice.e. Pairs or triplets of options that clue the test-taker to the
correct choice.13. Make all distractors plausible.
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Absolute terms
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Grammar cues
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Word repeat
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Inconsistency
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Guidelines for EMQ
• Identify the theme for the set.
• Write the lead-in for the set.
• Prepare the list of options.
• Write the items.
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Thank you