School is back in full swing, and it is a good time for refreshing multiple-choice question (MCQ) exams. Download the following one-page guide for 5 basic steps of item writing.

Focus on one concept per item based on the desired learning outcomes: Make sure your learning objectives, assessment, and teaching strategies align so that your testing content is not “a surprise.”

Chose a level of cognition that matches the expected outcomes: Compose a clear question stem that asks examinees to apply their expected scope of knowledge (not your scope of knowledge) to a scenario. Be careful to recognize the line between expert and novice.

Avoid common errors: “All of the above” and “none of the above” options and negative phrasing such as “which of the following is not…” or “all of the following, except…” are common pitfalls when writing test items.

Construct the correct answer: Accompany the correct answer with 1 close-to-correct option and approximately 2-3 plausible distractors. Aim for answers that are of similar length, structure, and form.

Use data to revise future exams: The difficulty index, discrimination index, and distractor analysis can offer valuable information about how students responded to questions and can guide educators in making improvements.

Another practical resource that should be on every educator’s desk is the Dory et al. one-page MCQ decision making guide. For more detailed information, go to the National Board of Medical Examiners (NBME) Item Writing Manual and Online Tutorial.  

#MedEdPearls are developed monthly by the Central Group on Educational Affairs. Previously, #MedEdPearls explored topics including small group instructional diagnosis, ACGME faculty development requirements, and peer observation.  

Note: The one-page guide was created by Dr. Sarah McBrien for the University of Nebraska Medical Center Thrive Collection for medical educators. There is also a complete collection of short, focused success strategies for modern day educators, as well as a companion guide for developing learning objectives with appropriate assessment strategies.


Author BIO

Linda M. Love, EdD is a health professions educator and organizational developer. She is the Director of Faculty Development, an Interprofessional Academy of Educators Scholar, and Assistant Professor in the Department of Psychiatry at the University of Nebraska Medical Center. Linda’s areas of professional interest include career development and professional identity development of medical educators, developing new generations of health professions educational leaders, and teaching/learning in the Information Age. Linda can be followed on Twitter or contacted via email.


#MedEdPearls Team:
Jean Bailey, PhD – Virginia Commonwealth University School of Medicine
Carrie Bowler, EdD, MS, MLSCM (ASCP) – Mayo Clinic
Kristina Dzara, PhD, MMSc (Educators ’16; Assessment ’16; HCE 2.0 ’17) – Saint Louis University School of Medicine
Shanu Gupta, MD – University of South Florida and Tampa General Hospital
Jennifer Hillyer, PhD – Northeast Ohio Medical University College of Medicine
Larry Hurtubise, PhD (HCE 2.0 '16) – The Ohio State University
Anna Lama, EdD – West Virginia University School of Medicine
Machelle Linsenmeyer, EdD, NAOME (Assessment ’07) – West Virginia School of Osteopathic Medicine
Rachel Moquin, EdD, MA – Washington University School of Medicine in St. Louis
Stacey Pylman, PhD – Michigan State University College of Human Medicine
Leah Sheridan, PhD – The Ohio University Heritage College of Osteopathic Medicine
Lonika Sood, MBBS, MHPE – Elson S. Floyd College of Medicine, Washington State University
Mark Terrell, EdD – Lake Erie College of Osteopathic Medicine
Stacey Wahl, PhD – Virginia Commonwealth University School of Medicine