Introduction
The objective type of questions provides a distinct advantage of being more reliable not only because of predetermined correct answer but also because of the more content being tested.1 Multiple choice question (MCQ)/item is one of the common objective type of questions, which is being used extensively in most of the examinations. In fact, it signifies one of the most essential well-established examination tools widely used in assessment at the undergraduate and postgraduate levels of medical examinations.2
Well-constructed MCQs can be an effective and efficient way to assess learning outcomes.1 Several guidelines are available from various resources regarding construction of MCQ/item.2, 3, 4 However, easy to remember and mnemonic based guidelines on MCQ construction are sparse in the literature. The present paper was intended to provide simplified mnemonics in the form of ABCD like alphabets for MCQ construction, so that medical educators can easily incorporate it into their regular teaching practices.
All the above/ None of the above Questions
Try to avoid these two options as far as possible. For instance, in case of ‘all of the above’ option, if students recognize two correct options, they may easily tick ‘all of the above’ option without reading third option.
Beginning Section
Provide clear instructions to the students regarding type of questions, scoring system, allotted time etc.
Central Theme
Maintain single central theme for each item. For example, instead of focusing on signs, symptoms as well as treatment of sunstroke, it is better to focus on one theme rather than focusing on different aspects like signs, symptoms and treatment of sunstroke in single item.
Distractors
Experts generally recommend 4 options (one key and three distractors) in MCQ. It is crucial to ensure the quality of distractors. If you have 3 options and unable to think of 4th effective option, leave the options at 3 rather than 4. Select only the most plausible distractors (alternatives) and arrange them in the form of options.
Emphasis on Higher-Level Thinking Questions
Use memory-plus application questions as they need students to recall principles, facts as well as real life context.
Facility Value and Discrimination Index
These two indices are essential aspects of ‘Item analysis’. The items having these indices within the acceptable limits must be retained for further use.
Grammar
Use simple, precise and unambiguous words in an item. Students will be more likely to choose the right option by finding the grammatically correct option.
Hints to Correct Answer
Avoid answering one question in the test by giving the answer somewhere else in the test. Avoid giving clues by use of a/an. For example – “ Imipramine is an ….. Antidepressant (option)”
Independent and Complete Item
Each item should be complete and independent. If a subsequent item depends on the previous item, students may be penalized twice for one incorrect option.
Judgment and Problem-Solving Knowledge and Understanding
Construct an item as per Bloom’s Taxonomy including Knowledge, Comprehension, Application, Analysis, Synthesis and Evaluation.
Key Answer should be the Best Choice
In item, key answer should be the best choice. If there is ambiguity or any subjective element in an item, it may confuse students.
Language
Use language which is appropriate to the level and vocabulary of students. For example – For Hepatitis A spread, ‘Droplet infection’ seems to be appropriate instead of ‘Tiny air molecules’.
Multiple Text
Avoid repetition of words. If there are common words in the options, they must be included in the stem. For example – for protein requirement of Indian reference man (stem), there is no need to write per kg body weight in each option. It can be included in stem only.
Negative Words
Avoid using negative words in stem or its use should be minimum. If they are inevitable, highlight them in the form of capitals, italics or by underlying them. Avoid double negatives at any cost. For example - “Which of the following is not a loop diuretic except”.
Options Length
Length of option may help students to make guesswork without knowing the answer. Avoid making too long or too short answer. Maintain the uniformity in length of all options.
Peer Evaluation
Make corrections if any in given item before proceeding. One of the best strategies to ensure the quality of items is to have them checked by your colleagues. It has been documented that half of the items are discarded as ‘not good’ by using this strategy.
Question Format should be Standard
Write stem on top and begin the options from next line. Each option should be in one line. The options may be numbered like a, b, c, d instead of 1,2,3,4 because students may get confused later with serial number of the item.
Rank Order of Options
All options in an item must be arranged in rank order so that, students do not have to hop through the options to find out the correct answer.
Testing of Various Domains
Each item should be supplemented with specific learning objectives and learning domains (cognitive, psychomotor and affective) need to be identified for each item.
Unambiguous and Inarguably Correct Answer
Cross check the accuracy of the answer. Make sure that it should be unambiguous and unarguably the correct answer.
Vague Terminologies
Avoid using words like ‘excellent’, ‘majority’, ‘fairly high’, ‘always’, ‘never’, ‘usually’ in item. These types of words can confuse students.
Window Dressing of Stem
Avoid superfluous and unnecessary words in stem which can confuse the students. In short, avoid ‘flowery language’ in item.