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Leah Stanford
Leah Stanford

Savvy Strategies

Published on Friday, October 25, 2024

By: Leah Standord

Questionable Decisions... Tips for Writing Exam Items

The new curriculum integration for preclinical courses has created many opportunities for growth, and not just for students. Faculty have also had to flex their muscles and learn new skills along the way. One of those skills is writing items for exams. Exams for M1 and M2 courses have been developed based on the format utilized on NBME exams. Well written exam questions should include:

  • Alignment to the lecture objectives- In most cases, one question per objectives is sufficient. It also helps when the lecture and objective alignment is submitted with the question.
  • ONE, most correct answer- Answer choices such as “All of the Above” or “None of the Above” are ambiguous. These options often cue a test taker to use the process of elimination.
  • Positive structure- Questions that include “All of the following EXCEPT...” do not ask the test taker to find the most correct answer. This language also creates opportunities for test-takers to misread the question.
  • Application of concepts, not memorization- The ultimate goal of the M1 and M2 years is preparation for treating future patients. Assessing their application through clinical scenarios, or vignettes, is the best way to determine mastery.

Example:

A healthy, moderately active 75-year-old woman is found on routine screening to have a total serum cholesterol concentration of 208 mg/dL and serum HDL-cholesterol concentration of 70 mg/dL. ECG shows no abnormalities. Which of the following dietary recommendations is most appropriate?

  1. Decreased intake of cholesterol
  2. Decreased intake of saturated fat
  3. Decreased intake of simple carbohydrates
  4. Increased intake of fiber
  5. No change in diet*

You can see that this question includes all of the necessary information to make the correct recommendation for the patient. Questions such as this allow the test-taker to use their learning along with the provided information to select the correct answer. One way to determine if you have written a well-constructed item is to ask yourself “Could this question be answered without seeing the answer options?” If the answer is “Yes”, then you have written a great question for the exam! If you are still unsure, contact me at lstanford1@umc.edu.