Vb. Best Practices in Writing MCQs
D. Clarity and Ambiguity
2) Avoid absolute terms like "always" or "never" unless they are factually correct.
2) Avoid absolute terms like "always" or "never" unless they are factually correct.
The use of absolute terms in multiple-choice questions (MCQs) can lead to potential misinterpretation and shift the focus away from the subject matter. To avoid this, precision in language is important, using terms like "typically" or "in general" when there are exceptions. Fact-checking and peer review can also help ensure the accuracy of statements in MCQs, while keeping the focus on assessing knowledge or competency.
BASIC Information
Absolute terms such as "always" or "never" imply that there are no exceptions to the statement being made. While these terms can sometimes be accurate, they can also inadvertently introduce ambiguity unless the content they describe is genuinely absolute.
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Educated Guessing Strategies for Multiple Choice TestsQuestion: "Patients with high blood pressure should always avoid which of the following?"
a) Exercise
b) Salt
c) Drinking water
d) Fresh fruits
Here, the term "always" suggests that there is no situation in which a patient with high blood pressure can have salt, which is an oversimplification. While reducing salt intake is often advised, it's not a universal "always" rule.
INTERMEDIATE Information
Potential Misinterpretation: Absolute terms can create traps, making students question their knowledge based on the rigidity of the statement.
Obfuscating the Question's Aim: The use of absolute terms can shift the student's focus from the subject matter to the validity of the statement.
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A practical discussion to avoid common pitfalls when constructing multiple choice questions itemsQuestion: "A patient diagnosed with congestive heart failure should never consume which of the following?"
a) Antioxidant supplements
b) Alcohol
c) Vitamin C
d) Green leafy vegetables
The word "never" in this question can be misleading. While it's true that excessive alcohol consumption is harmful for CHF patients, some doctors might permit limited and occasional intake. Thus, the term "never" could lead to debate and confusion.
ADVANCED Information
Precision in Language: When designing questions, it's vital to choose words that convey the exact meaning intended. If there are exceptions, it's better to use terms like "typically," "often," or "in general."
Fact-Checking and Peer Review: This process will ensure that statements made in questions are accurate. Colleagues can often catch misleading phrasings that the original writer overlooked.
Focusing on Core Objectives: Remember that the aim of an MCQ is to assess knowledge or competency in a given area. It's not to trick or confuse the test-taker.
Instead of:
Question: "Patients post myocardial infarction (MI) should always avoid which of the following medications?"
a) Beta-blockers
b) Nitroglycerin
c) NSAIDs (like Ibuprofen)
d) Statins
A clearer phrasing would be:
Question: "Which of the following medications is typically contraindicated for patients post myocardial infarction (MI)?"
Using "typically" makes the question more accurate. While NSAIDs are generally avoided post-MI due to the risk of further cardiac events, there might be specific cases or conditions under which they might be used.
By eliminating absolute terms in favor of more nuanced wording, MCQs can more effectively and fairly evaluate a student's understanding of the topic at hand.