Vb. Best Practices in Writing MCQs
B. Question Structure- Options
2) Typically, use three to five options to maintain a balance between reliability and feasibility.
2) Typically, use three to five options to maintain a balance between reliability and feasibility.
The number of options in a multiple-choice question (MCQ) includes the correct answer and distractors. Increasing the number of options can improve the ability to distinguish between high-performing and low-performing students, but it can also make the question more challenging and overwhelming for students. Studies suggest that the focus should be on the quality of the distractors rather than the quantity of options.
BASIC Information
The number of options in a multiple-choice question (MCQ) refers to the total choices provided, including the correct answer and distractors.
VIDEO
Writing five star multiple choice questions MCQ for your medical coursesIt's a good practice to present between three to five options. Too few can make the question too easy; too many can make it overly complex and time-consuming.
READ
Analysis of MCQ and distractor use in a large first year Health Faculty Foundation Program: assessing the effects of changing from five to four optionsREAD
Adding to the debate on the numbers of options for MCQs: the case for not being limited to MCQs with three, four or five optionsINTERMEDIATE Information
Reliability: Increasing options can make the question more challenging, improving the ability to distinguish between high-performing and low-performing students.
Feasibility: However, generating plausible distractors can be tough. Moreover, more options can be overwhelming and time-consuming for students.
READ
A comparison of 3- and 4-option multiple-choice items for medical subspecialty in-training examinationsREAD
The optimal number of options for multiple-choice questions on high-stakes tests: application of a revised index for detecting nonfunctional distractorsThree Options: Suitable for basic, factual questions.
Four Options: Offers a good balance for most questions.
Five Options: Useful for more complex questions, but avoid using frequently due to the difficulty of creating meaningful distractors.
READ
Multiple choice questions: a literature review on the optimal number of optionsQuestion: "A patient presents with fatigue, weight gain, and constipation. What could be a potential diagnosis?"
Options:
a) Type 2 Diabetes
b) Hyperthyroidism
c) Hypothyroidism
d) Vitamin D deficiency
Here, four options are provided, each related to the presented symptoms. It’s a balanced approach for students who have a deeper understanding of endocrine disorders.
ADVANCED Information
Ensuring Distractor Quality: The more distractors, the harder it is to ensure each one is plausible. Poor distractors can inadvertently hint at the correct answer.
Cognitive Load: Overloading students with options can result in decision fatigue, making questions seem more complicated than intended.
Research Insights: Studies suggest little to no significant difference in terms of exam reliability when moving from five to three distractors. The primary focus should be on distractor quality rather than quantity.
READ
Adding to the debate on the numbers of options for MCQs: the case for not being limited to MCQs with three, four or five optionsAvoid Overuse of "All of the above": This can sometimes give away the answer if one or two of the options are clearly correct/incorrect.
Distractor Analysis: Post-examination, analyze how students chose distractors. If a distractor wasn't chosen by any student, it might not be plausible and should be re-evaluated.
READ
Decreasing the options’ number in multiple choice questions in the assessment of senior medical students and its effect on exam psychometrics and distractors’ functionQuestion: "A 60-year-old male patient with a history of smoking and hypertension presents with a sudden onset of severe chest pain radiating to the left arm. What is the most immediate concern?"
Options:
a) Acute myocardial infarction
b) Chronic obstructive pulmonary disease (COPD) exacerbation
c) Gastroesophageal reflux disease (GERD)
d) Pulmonary embolism
e) Costochondritis
In this advanced scenario, five options are provided, each being potential diagnoses for chest pain. However, given the specifics of the case (age, smoking history, hypertension, nature of the pain), a well-prepared student might lean towards option 'a'. The distractors serve to challenge students on their differential diagnosis skills.