Multiple Choice Questions - Item writing & item analysis 15 th April 2014 Jane Holland MD PhD MRCSI RCSI Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn including slides from Richard Arnett, PhD
Multiple Choice Questions -
Item writing & item analysis
15th April 2014
Jane Holland MD PhD MRCSI
RCSI Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn
including slides from Richard Arnett, PhD
MCQ Item writing & item analysis - Outline
Introduction to item-writing
Response formats
Stimulus formats
Technical item flaws
Introduction to item analysis
Jane Holland
http://www.nbme.org/publications/item-writing-manual.html
MCQ response formats
• True / False
The candidate is required to make a determination
as to whether each option provided is true or false
• One Best Answer
The candidate is required to indicate a single
response i.e. the most likely diagnosis
NBME Manual p 13 – 18
Schuwirth: Med Educ. 2004 Sep;38(9):974-9.Jane Holland
True / false vs. Single Best Answer
False True
(Simple true/false items)
(Complex true false items)
Q. True statements about dogs include:
A. They were first domesticated in New Zealand.
B. 35% of households own at least one dog.
C. They have a field of vision up to 200°.
D. They communicate by barking.
Jane Holland
True / false vs. Single Best Answer
Q. Which Irish rugby union player holds the record
for most international caps?
A. D’Arcy
B. Heaslip
C. Kearney
D. O’Connell
E. O’Driscoll
Jane Holland
Q. Which of the following statements about Ireland
is true?
A. Tayto exports exceed € 1 Bn
B. The climate is sub-tropical
C. The main export is zinc
D. The population is 5 million
E. Rainy weather frequently occursX
True / false vs. Single Best Answer
Trade / exports
Weather
DemographicsD
C
B
A
E
Jane Holland
True / false vs. Single Best Answer
Q. What colour is the sky?
A. A hazy shade of winter
B. Blue
C. Grey
D. Orange
E. Red
Jane Holland
Q. Which of the following calls is a rugby union referee most
likely to make in the case of an intercepted knock-on?
A. Advantage
B. Line out
C. Penalty kick
D. Penalty try
E. Scrum
Q. Which of the following was an original recording by
Meatloaf?
A. Bat out of Hell
B. One out of three ain’t bad
C. Paradise by the Kitchen Light
D. Stand by me
E. Total Eclipse of the Heart
Jane Holland
The “cover test”
MCQs – how many options?
Jane Holland
Swanson et al; Academic Medicine. 2005;80(10):S93-S6.
Tarrant & Ware; Nurse Education Today. 2010;30(6):539-43.
Stem /
vignette
Question
(Lead-in)Options
Single Best Answer
Jane Holland
MCQ stimulus formats
Context -free
Tests factual
knowledge
Context-rich
Tests reasoning
or application
Schuwirth: Med Educ. 2004 Sep;38(9):974-9.
Kennedy, 2007Jane Holland
Creating
Evaluating
Analysing
Applying
Understanding
Remembering
NBME Manual p 35 - 49
Q. Which dermatome is at the umbilicus?
A. T6
B. T8
C. T10
D. T12
E. L2
Q. A 65-year-old librarian presents with skin lesions
suggestive of a Herpes zoster infection affecting
the dermatome which includes the skin of the
umbilicus.
Which segmental spinal nerve is associated with
that dermatome?
Jane Holland
Q. A 6 year old boy is admitted with a history of colicky
abdominal pain which has now localised to his right
iliac fossa.
The initial, visceral pain felt with appendicitis is
referred along sympathetic fibres from which level
of the spinal cord?
A. T6
B. T8
C. T10
D. T12
E. L2
NBME Manual p 35 - 49Jane Holland
Stem
Lead-in
Options
Clinical (or contextual) vignette
• Age / gender
• Presenting Problem / history
• Examination findings / test results
Which of the following is the most:
• Likely diagnosis
• Appropriate treatment
Homogenous
• One correct & 4 distractors
• Alphabetical (or logical) order
• All plausible & same length (short!)
NBME Manual p 35 - 49Jane Holland
Q. Which of the following Moodle activities
allows participants to select a single
option from a list?
A. Checklist
B. Choice
C. Forum
D. Survey
E. Workshop
Jane Holland
Q. Gavin is running a conference, at which there will
be a number of parallel workshops with limited
places. Which of the following Moodle activities
could he use to allow participants to preselect
their preferred workshop?
A. Checklist
B. Choice
C. Forum
D. Survey
E. Workshop
Jane Holland
Q. Which of the following Moodle activities
allows participants to select one choice
from a list of options?
Word repeats
Jane Holland
A. Checklist
B. Choice
C. Forum
D. Survey
E. Workshop
Grammatical
clues
Long
correct
answer
Absolutes
Word
repeats
Logical
cues
Convergence
Technical
Item flaws
NBME Manual p 19 - 27Jane Holland
Q. Which of the following Moodle activities
allows participants to select one choice
from a list of options?
Word repeats
Jane Holland
A. Checklist
B. Choice
C. Forum
D. Survey
E. Workshop
Q. It is extremely important for teachers to
maintain a healthy diet. Therefore,
students should always give them an:
A. Apple
B. Banana
C. Bread roll
D. Chocolate bar
E. Mohito
Grammatical clues
Jane Holland
a / an
plural / singular
Q. A 76 year old diabetic is brought into the accident
and emergency department with suspected
diabetic ketoacidosis. After confirming that she is
hyperglycaemic, the first step in management
should be intravenous administration of:
A. Chest X-ray
B. Electrocardiogram
C. Fasting blood glucose level
D. Insulin
E. Placement of an nasogastric tube
Grammatical clues
Jane Holland
Word repeats
Q. A 58 year old man with a history of heavy alcohol
use and previous psychiatric hospitalisation is
confused and agitated. He speaks of experiencing
the world as unreal. This symptom is called:
A. Depersonalisation
B. Derailment
C. Derealisation
D. Focal memory deficit
E. Signal anxiety
Jane Holland
Logical clues
Q. Crime is:
A. Equally distributed among the social classes
B. Overrepresented among the poor
C. Overrepresented among the middle class &
rich
D. Primarily an indication of psychosocial
maladjustment
E. Reaching a plateau of tolerability for the nation
Jane Holland
Also be wary of overlapping numericals...
Convergence Strategy
Q. Local anaesthetics are most effective in the:
A. Anionic form, acting from inside the
nerve membrane
B. Cationic form, acting from inside the
nerve membrane
C. Cationic form, acting from outside the
nerve membrane
D. Uncharged form, acting from inside the
nerve membrane
E. Uncharged form, acting from outside the
nerve membrane
Jane Holland
Long correct answer
Q. Secondary gain is:
A. Synonymous with malingering
B. A frequent problem in OCD
C. A complication of a variety of illnesses and
tends to prolong many of them
D. Never seen in organic brain damage
Jane Holland
Absolutes...
Q. Which of the following shoes are never
worn by men?
A. Boots
B. Runners
C. Sandals
D. Stilettos
E. Wellies
Jane Holland
Absolutes
Holsgrove G, Medical Education 1998; 32: 343 - 350
Jane Holland
0
10
20
30
40
50
60
0% 1% 5%
“Never”
0
10
20
30
40
50
60
80% 95% 99% 100%
“Always”
Jane Holland
Shape Long vignette & stem short options
Cover test
• Ideally can know the correct answer before seeing the
possible options
Use homogenous distracters
• i.e. all arteries, all medications, all diagnoses
• Grammatically consistent
• Logically compatible
• List in logical or alphabetical order
Don’t use vague frequency terms
Never use absolutes!
Do not write a negative question!!
NBME Manual p 35 - 49
Some useful principles
Jane Holland
Jane Holland
Difficulty Discrimination
Corrected
Point
Biserial
Distractor
Choice
Introduction to Item Analysis
Classical Test Theory
Item Response Theory (IRT)
Generalizability Theory (G-Theory)
Richard ArnettDe Champlain: Med Educ. 2010; 44:109-117.
How did the items / questions perform??
1. What proportion of candidates got the
question correct?
2. Which options were chosen most frequently?
3. Which options were chosen by low, medium
and high performers on the test as a whole?
4. How did success on an item correlate with
overall test score?
Jane Holland
Difficulty Discrimination
Corrected
Point
Biserial
Distractor
Choice
De Champlain: Med Educ. 2010; 44:109-117.
Item difficulty (DIF) – or facility
What proportion of candidates got the question correct?
90% of candidates answered correctly
DIF = 0.90
< 0.40 – hard
> 0.80 – easy
0.40 – 0.80 – good question
0.45 – 0.55 are extremely discriminating
Jane Holland
Which options were chosen most frequently?
Distractor choice
Examine the proportion of candidates choosing
each option
ALL options should be chosen by candidates
Replace any options not chosen
Jane Holland
Discriminating Index (or power)
Which options were chosen by low, medium
and high performers on the test as a whole?
Lower 27% Upper 27%Middle
L
N
U
U – L
N= DI
Ideally, DP should be > 0.40
Jane Holland
Jane Holland
Richard Arnett
Additional measures of Discrimination
Point biserial correlation (RPB)
Equivalent to Pearson correlation co-efficient
Is a measure of association between a binary (nominal)
variable and a continuous variable
Corrected point biserial correlation (CRPB)
The item is removed from the test total prior to calculation
Range = -1 to +1
>0.2 good, <0.2 weak
Negative – inverse relationship!!!!
Jane Holland
Jane Holland
Jane Holland
Jane Holland
Moodle Quiz statistics
Item Difficulty...
Jane Holland
In a quiz with random questions...
Position of items within the test may change
Therefore, analyses must distinguish between positions in
the test, and test items
Students may answer different sets of questions
i.e. Answer 30 out of 50 possible questions from the bank
Np
N
Click on the quiz, then access:
Administration
Quiz administration
Results
Statistics
Jane Holland
Jane Holland
Jane Holland
Jane Holland
Good Stats Good Questions
Good stats don’t necessarily mean good
questions and good questions don’t
always get good stats...
...but it is a good place to start
Richard Arnett