Vb. Best Practices in Writing MCQs
D. Clarity and Ambiguity
1) Do not use double negatives.
1) Do not use double negatives.
Double negatives in sentences can cause confusion and may not be immediately recognized by readers, which is especially problematic in multiple-choice questions. Beyond confusion, double negatives can mislead students and cause frustration, impacting their confidence and performance on subsequent questions. In advanced assessment design, unclear questions with double negatives undermine the intention to promote higher-order thinking.
BASIC Information
Double negatives in a sentence can create confusion because they often lead to positive statements, but their presence may not be immediately recognized by the reader. This can be especially problematic in MCQs where clarity is vital.
Question: "Which of the following is not an inappropriate method to diagnose anemia?"
a) Hemoglobin test
b) Stool test for parasites
c) X-ray of the chest
d) Blood smear
Here, the double negative (not inappropriate) makes the question cumbersome. It could easily be reworded for clarity, such as, "Which of the following is an appropriate method to diagnose anemia?"
INTERMEDIATE Information
Beyond mere confusion, double negatives can:
Mislead the Student: Students might spend unnecessary time decoding the question rather than answering it based on their knowledge.
Cause Frustration: If not recognized, double negatives can lead to misunderstandings, which could impact the student's confidence and performance on subsequent questions.
READ
Negatively-Worded Multiple Choice Questions: An Avoidable Threat to ValidityQuestion: "Which of the following is not an unsuitable treatment for a patient with type 1 diabetes presenting with hypoglycemia?"
a) Administering insulin
b) Giving oral glucose
c) Glucagon injection
d) IV saline solution
In this situation, the question asks which treatment is suitable (due to the double negative). A more direct phrasing would be, "Which of the following is a suitable treatment for a patient with type 1 diabetes presenting with hypoglycemia?"
ADVANCED Information
In advanced assessment design, the intention is not just to evaluate but also to promote higher-order thinking. This aim is undermined by unclear questions.
Review and Revise: Questions should undergo several rounds of reviews. Peer review can be especially helpful in catching confusing phrasings.
Focus on the Learning Outcome: The central aim of any question is to gauge understanding or application of knowledge. Anything in the question that doesn't serve this purpose, including double negatives, should be eliminated.
Instead of:
Question: "In cases of a tension pneumothorax, which of the following is not an incorrect immediate intervention?"
a) Needle decompression
b) Administration of oxygen
c) IV antibiotics
d) Inserting a chest tube
A clearer phrasing would be:
Question: "In cases of a tension pneumothorax, which of the following is an immediate intervention?"
By rephrasing, the question focuses on the student's understanding of tension pneumothorax interventions rather than their ability to decipher a convoluted question.