MCQMCQMultiple Choice Questions

Why concern?Why concern?

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Why still be used?Why still be used?

• reliability • content validity • practicality

Why educator hate it?Why educator hate it?

• poor MCQ–validity

• patient doesn’t come with choices!

–lower order thinking• recall

First ConclusionFirst Conclusion

• It still be used

• National licensing examination–Part I: basic sc 300 items

–Part II: clinical sc 450 items

• We have to improve ourselves

How to construct?How to construct?

• planning

• writing

• reviewing and revising

• publishing

How to improve?How to improve?

• knowledge

• skill

• attitude

Basic KnowledgeBasic Knowledge

• Theoretically; MCQ = –one best answer, +

–matching, +

–extended matching, + etc

• Practically; –MCQ => one best answer

PlanningPlanning

• identify the outcome–Medical Council Standard

–cognitive domain

Cognitive DomainCognitive Domain

knowledgeknowledge

comprehensivecomprehensive

applicationapplication

analysisanalysis

synthesissynthesis

evaluationevaluation

recallrecall

interpretationinterpretation

-problem solving-problem solving

ApplicationApplication

recallrecall

PlanningPlanning

• identify the outcome–Medical Council Standard

–cognitive domain

• identify number of item–time => 150 item : 180 min

–formula

• table of specification

Table of SpecificationTable of Specification

สาระน้ำ��าหน้ำก(รวม

100%)

จำ�าน้ำวน้ำข้�อสอบ

(รวม 300

ข้�อ)B1 General Principles 33% 100

B1.1 Biochemistry and molecular biology 10% 10

B1.2 Biology of cells 10% 10

B1.3 Human development and genetics 10% 10

B1.4 Biology of tissue response to disease 10% 10

B1.5 Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environment

5% 5

Table of SpecificationTable of Specification

สาระ น้ำ��าหน้ำก(รวม

100%)

จำ�าน้ำวน้ำข้�อสอบ

(รวม 300 ข้�อ)

B1 General Principles 33% 100

B1.6 Multisystem processes 10% 10

B1.7 Principles of specimen collections and laboratory interpretations

5% 5

B1.8 Pharmacodynamic and pharmacokinetic processes

10% 10

B1.9 Microbial biology and infection 10% 10

B1.10 Immune responses 10% 10

B1.11 Quantitative methods 10% 10

Table of SpecificationTable of Specification

สาระ น้ำ��าหน้ำก(รวม

100%)

จำ�าน้ำวน้ำข้�อสอบ

(รวม 300 ข้�อ)

B2 Hematopoietic and Lymphoreticular System 7.4% 22

B2.1 Normal processes 40% 9

B2.2 Abnormal processes 40% 9

B2.3 Principles of therapeutics 10% 2

B2.4 Gender, ethnic, and behavioral considerations affecting disease treatment and prevention, including psychosocial, cultural, occupational, and environment

10% 2

Table of SpecificationTable of Specification

• Cognitive taxonomy ratio–recall : application

• basic sciences = 50:50

• body system = 30:70

PlanningPlanning

• identify the outcome–Medical Council Standard

–cognitive domain

• identify number of item–time => 150 item : 180 min

–formula

• table of specification

WritingWriting

• 1 item = stem + options• stem• options / choices

–1 answer / key–3-4 distracters

• avoid testwiseness• avoid irrelevant difficulty

Good StemGood Stem

• Valid

• What? => TMC standard

• Which aspect? => Form

• How deep? => For GP

Good StemGood Stem

• avoid–trivial fact

• color reagent

• enzyme

–extreme recall• the second most common

• the least common

Good StemGood Stem

• 1 stem = 1 aspect

• No more –What are … and …?

• Usually long stem + short options

• Don’t teach in the test!

Good StemGood Stem

• 1 stem = 1 aspect

• No more –What are … and …?

• Usually long stem + short options

• Don’t teach in the test!

Good StemGood Stem

• Vignette + leading question

Item template : Gross anatomy A (patient description) is unable to (functional disability). Which of the following is most likely to have been injured?

A 65-year-old man has difficulty rising from a seated position and straightening his trunk, but he has no difficulty flexing his leg. Which of the following muscles is most likely to have been injured?

Good StemGood Stem

Item template : A (patient description) has (history findings) and is taking (medications). Which of the following medications is the most likely cause of his (one history, PE or lab finding)?

Item template :A (patient description) has a (type of injury and location). Which of the following structures is most likely to be affected?

Good StemGood Stem

Item template :A (patient description) has (abnormal findings). Which [additional] finding would suggest/suggests a diagnosis of (disease 1) rather than (disease 2)?

Item template :A (patient description) dies of (disease). Which of the following is most likely finding on autopsy?

Good StemGood Stem

A patient has (abnormal findings) but (normal findings). Which of the following is the most likely diagnosis?

Item template : A patient has (symptoms and signs). Which of the following is the most likely explanation for the (findings)?

Good StemGood Stem

• Series of stems are fine–BUT independent

Good StemGood Stem

• Should not –What do you think?

Good StemGood Stem

• allow data gathering

• provide a sizable data base

• simulate reality

• include appropriate “noise”

• start with problem, not a diagnosis

• use unfamiliar (not uncommon) case

• test only cognitive objective

• avoid diagnostic label

Good OptionsGood Options

• same direction

• similar length, otherwise–long answer + short distracters

• similar style, otherwise–nice answer (copy from textbook) +

poor distracters

Good DistractorsGood Distractors

• incorrect!

• reasonable

• common misunderstanding

• common mistakes

Options TidinessOptions Tidiness

• sequencing–alphabetical

–length

–chronological

–logical

• word repeated

TestwisenessTestwiseness

• grammatically guide

• totally, absolutely, none, etc

• latin translation

• all of above, none of above, K type

• question A => answer of question B

Unawares, the answerUnawares, the answer

• is usually the option which is–longest

–looked nicest

–most understandable

–appeared most frequent

Irrelevant difficultyIrrelevant difficulty

• poor written, poor chart

• double negative

• too long, too complicated

• difficult vocabulary, jargon

• unordered number

• subjective : often, usually

• tricky

How to construct?How to construct?

• planning

• writing

• reviewing and revising–self-test

–pilot / colleagues

• publishing–readable

How to improve?How to improve?

• Knowledge

• Skill

• Attitude

SkillSkill

• Practicing–Form

–Item development team

–Item analysis

MiscellaneousMiscellaneous

• AI

• p

• r

• item sequencing

ConclusionConclusion

• Knowledge

• Skill

• Attitude