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October #MedEdPearls: Resources to ease MCQ test writing anxiety

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 This email address is being protected from spambots. You need JavaScript enabled to view it..

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Friday, 28 January 2022