Guidelines for

preparing Multiple
Choice Questions
(MCQs) 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 MCQs *
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

Case and Swanson, 2001

complex

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, Horners 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,
Alzheimers 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,
Alzheimers 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.