Guidelines for Writing Single-Best MCQS/SEQs

1. Each MCQ should test an important concept, and not trivial facts.
2. Each MCQ should test higher levels of cognition i.e. application of knowledge (C2 and C3 levels) including interpretation and analysis of data, critical thinking and problem solving, and not just recall of facts. This becomes easier if the stem is based on a clinical vignette.
3. All MCQs should be original and indigenous as MCQs copied from books or internet may not only fail to provide a relevant social or cultural context to the clinical scenarios, but they also lose their problem-solving quality as it is very likely that the answer to the problem being posed is already known to the students.
4. Structure of single best MCQ:
a) Stem: Clinical scenario (Vignette)
b) Lead in: follows the stem.
c) Options: Five; one is best while other four serve as plausible distracters.
a) Stem/ Clincal case scenario (vignette):
A vignette or clincal scenario incudes desciption of a patient with all or some of the information given below:
Age, Gender (e.g. A 45-year-old man)
Site of Care (e.g. emergency department)
Presenting complaint (e.g. annoying pain in knee)
Duration (e.g. since last 2days)
Personal History (e.g. active athlete)
Physical Findings (e.g swollen & tender knee)
Investigations (significant postive or negative findings)
Treatment/Management (may also include treatment given & its response)
b) Lead in:
A lead in poses a clear question or statement and follows the stem.
c) Options:
CPSP uses MCQs with five options. One of them is the most appropraite or best answer in that particular scenario while the other four serve as plausible distracters.

Example of MCQ (One Best Type) From Clinical Sciences:
A patient is brought to the emergency department. He is feeling ill, reports 'ringing' in his ears, has a heart rate of 90/min and the QRS intervals on his ECG are prolonged.
He says he is taking a 'heart drug' but does not know what it is.
The most likely drug he is using is:

A. Captopril
B. Digoxin
C. Phenytoin
D. Propanolol
E. Quinidine ? (? correct answer)
Format of MCQs
Each MCQ should be have the following characteristics:
a) Should test an important area/concept/objective.
b) 'Stem' of an MCQ should include clinical scenario and the task (Lead-in) for students.
c) Use simple language in the stem and include only the necessary information and lab tests for constructing the scenario.
d) Since each MCQ has to be read, understood and answered within 1.5 minutes, the scenario should be brief (100-110 words).
d) Stem should be followed by five homologous options (all options should be of the same category whether related to diagnoses or investigations or etiology or management steps, etc)
e) Marked as A, B, C, D, E.
f) One of the five options should be clearly (indisputably) the best, while the others should attract (or distract) the less informed students.
g) All options should be brief and similar in length including the best (correct) option.
h) Arrange options in a logical order (e.g. alphabetical order).
Avoid:
a) Use of double negatives in stem such as "the management of this disease does not include the following steps EXCEPT."
b) Using the word "EXCEPT."
c) Options 'All of the above' and 'None of the above', as they reduce the number of distracters and increase the chance of guessing.
d) Absolutes such as 'Always', 'Rarely' and 'Never' as they give a negative cue or 'Usually' 'Sometimes' which give a positive cue.
e) Grammatical inconsistencies, errors or cues or spelling mistakes.
f) Cueing from the stem into the options by words or language.
g) Abbreviations
Give the key at the end of options list for each MCQ.
Indicate the level for each MCQ on following parameters:
a) Importance: considered as 'Essential', 'Important' or 'Supplementary'
b) Difficulty: considered as 'Hard', 'Moderate' or 'Easy'
Use the latest edition of a standard textbook as a reference; mention also the page numbers of the book.
Write the name of author and date
Guidelines
Step by Step Guidelines for Writing MCQs
⇒ Choose the course i.e. MBBS/DPT/MD/MS/IMT
⇒ Fill required information
⇒ Read the topic of the chapter
⇒ Choose a theme (e.g. Pain in abdomen, Haematuria, etc)
⇒ Choose a sub-theme (e.g. Diagnosis, investigations, treatment)
⇒ Write them as under:

Theme: __________________________ Sub-theme (objective): ________________________
Make a list of options related to the selected theme and sub-theme.

Let us assume the theme is Pain in abdomen and sub-theme is Diagnosis. There are several diseases (diagnoses), which manifest with pain in abdomen. Write all these diseases (diagnoses) which come to your mind.
⇒ Select the homologous options. All options should be diagnoses (the diseases you have thought of) in the above example and not other things such as signs, symptoms, investigations or treatment)
⇒ Write them as under:

Provisional Option list:
Now select ONE option from the above list and mark it with an √. This option will be keyed as the correct (or best) answer for this MCQ
Write a vignette (case scenario) building upon the selected option (the diagnosis). It should briefly contain only the relevant portions of patient history, physical findings and results of investigations that could help the candidate to select the best available option (diagnosis). The scenario should not exceed 5-6 sentences to ensure that it could be read and understood in less than a minute.

Question Stem (Scenario):
⇒ Next look at other options in the provisional list and cross out the options that:
♦ Perfectly fit the scenario like the option with asterisk, as they are also best options.
♦ Are obviously incorrect for the given scenario, as no one is likely to opt for them.
Finally, reduce the option list to 5; keep 4 other options that sound plausible, but are less appropriate for the given scenario as compared to the option with asterisk (correct answer).
⇒ Transfer each MCQ developed to the MCQ Submission Form (Stage 2 form).