Multiple Choice Questions -
Item writing & item analysis
15th April 2014
Jane Holland MD PhD MRCSI
RCSI Royal College of S...
MCQ Item writing & item analysis - Outline
 Introduction to item-writing
 Response formats
 Stimulus formats
 Technica...
MCQ response formats
• True / False
 The candidate is required to make a determination
as to whether each option provided...
True / false vs. Single Best Answer
False True
 (Simple true/false items)
 (Complex true false items)
Q. True statements...
True / false vs. Single Best Answer
Q. Which Irish rugby union player holds the record
for most international caps?
A. D’A...
Q. Which of the following statements about Ireland
is true?
A. Tayto exports exceed € 1 Bn
B. The climate is sub-tropical
...

True / false vs. Single Best Answer
Q. What colour is the sky?
A. A hazy shade of winter
B. Blue
C. Grey
D. Orange
E. Re...
Q. Which of the following calls is a rugby union referee most
likely to make in the case of an intercepted knock-on?
A. Ad...
MCQs – how many options?
Jane Holland
Swanson et al; Academic Medicine. 2005;80(10):S93-S6.
Tarrant & Ware; Nurse Educatio...
Stem /
vignette
Question
(Lead-in)
Options
Single Best Answer
Jane Holland
MCQ stimulus formats
 Context -free
 Tests factual
knowledge
 Context-rich
 Tests reasoning
or application
Schuwirth: ...
NBME Manual p 35 - 49
Q. Which dermatome is at the umbilicus?
A. T6
B. T8
C. T10
D. T12
E. L2
Q. A 65-year-old librarian p...
Q. A 6 year old boy is admitted with a history of colicky
abdominal pain which has now localised to his right
iliac fossa....
Stem
Lead-in
Options
 Clinical (or contextual) vignette
• Age / gender
• Presenting Problem / history
• Examination findi...
Q. Which of the following Moodle activities
allows participants to select a single
option from a list?
A. Checklist
B. Cho...
Q. Gavin is running a conference, at which there will
be a number of parallel workshops with limited
places. Which of the ...
Q. Which of the following Moodle activities
allows participants to select one choice
from a list of options?
Word repeats
...
Grammatical
clues
Long
correct
answer
Absolutes
Word
repeats
Logical
cues
Convergence
Technical
Item flaws
NBME Manual p 1...
Q. Which of the following Moodle activities
allows participants to select one choice
from a list of options?
Word repeats
...
Q. It is extremely important for teachers to
maintain a healthy diet. Therefore,
students should always give them an:
A. A...
Q. A 76 year old diabetic is brought into the accident
and emergency department with suspected
diabetic ketoacidosis. Afte...
Word repeats
Q. A 58 year old man with a history of heavy alcohol
use and previous psychiatric hospitalisation is
confused...
Logical clues
Q. Crime is:
A. Equally distributed among the social classes
B. Overrepresented among the poor
C. Overrepres...
Convergence Strategy
Q. Local anaesthetics are most effective in the:
A. Anionic form, acting from inside the
nerve membra...
Long correct answer
Q. Secondary gain is:
A. Synonymous with malingering
B. A frequent problem in OCD
C. A complication of...
Absolutes...
Q. Which of the following shoes are never
worn by men?
A. Boots
B. Runners
C. Sandals
D. Stilettos
E. Wellies...
Absolutes
Holsgrove G, Medical Education 1998; 32: 343 - 350
Jane Holland
0
10
20
30
40
50
60
0% 1% 5%
“Never”
0
10
20
30
...
Jane Holland
 Shape  Long vignette & stem  short options
 Cover test
• Ideally can know the correct answer before seeing the
possib...
Jane Holland
Difficulty Discrimination
Corrected
Point
Biserial
Distractor
Choice
Introduction to Item Analysis
 Classical Test Theory...
 How did the items / questions perform??
1. What proportion of candidates got the
question correct?
2. Which options were...
Item difficulty (DIF) – or facility
 What proportion of candidates got the question correct?
90% of candidates answered c...
Which options were chosen most frequently?
 Distractor choice
 Examine the proportion of candidates choosing
each option...
Discriminating Index (or power)
 Which options were chosen by low, medium
and high performers on the test as a whole?
Low...
Jane Holland
Richard Arnett
Additional measures of Discrimination
 Point biserial correlation (RPB)
 Equivalent to Pearson correlation co-efficient
...
Jane Holland
Jane Holland
Jane Holland
Moodle Quiz statistics
 Item Difficulty...
Jane Holland
 In a quiz with random questions...
 Position of items within t...
 Click on the quiz, then access:
 Administration
 Quiz administration
 Results
 Statistics
Jane Holland
Jane Holland
Jane Holland
Jane Holland
Good Stats Good Questions
Good stats don’t necessarily mean good
questions and good questions don’t
always get good stats....
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MCQ Workshop - Dr Jane Holland

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MCQ Workshop - Dr Jane Holland RCSI

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www.moodlemoot.ie/

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MCQ Workshop - Dr Jane Holland

  1. 1. Multiple Choice Questions - Item writing & item analysis 15th April 2014 Jane Holland MD PhD MRCSI RCSI Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn including slides from Richard Arnett, PhD
  2. 2. MCQ Item writing & item analysis - Outline  Introduction to item-writing  Response formats  Stimulus formats  Technical item flaws  Introduction to item analysis Jane Holland http://www.nbme.org/publications/item-writing-manual.html
  3. 3. MCQ response formats • True / False  The candidate is required to make a determination as to whether each option provided is true or false • One Best Answer  The candidate is required to indicate a single response i.e. the most likely diagnosis NBME Manual p 13 – 18 Schuwirth: Med Educ. 2004 Sep;38(9):974-9. Jane Holland
  4. 4. True / false vs. Single Best Answer False True  (Simple true/false items)  (Complex true false items) Q. True statements about dogs include: A. They were first domesticated in New Zealand. B. 35% of households own at least one dog. C. They have a field of vision up to 200°. D. They communicate by barking. Jane Holland
  5. 5. True / false vs. Single Best Answer Q. Which Irish rugby union player holds the record for most international caps? A. D’Arcy B. Heaslip C. Kearney D. O’Connell E. O’Driscoll Jane Holland 
  6. 6. Q. Which of the following statements about Ireland is true? A. Tayto exports exceed € 1 Bn B. The climate is sub-tropical C. The main export is zinc D. The population is 5 million E. Rainy weather frequently occursX True / false vs. Single Best Answer Trade / exports Weather Demographics D C B A E Jane Holland
  7. 7.  True / false vs. Single Best Answer Q. What colour is the sky? A. A hazy shade of winter B. Blue C. Grey D. Orange E. Red Jane Holland
  8. 8. Q. Which of the following calls is a rugby union referee most likely to make in the case of an intercepted knock-on? A. Advantage B. Line out C. Penalty kick D. Penalty try E. Scrum Q. Which of the following was an original recording by Meatloaf? A. Bat out of Hell B. One out of three ain’t bad C. Paradise by the Kitchen Light D. Stand by me E. Total Eclipse of the Heart Jane Holland The “cover test”
  9. 9. MCQs – how many options? Jane Holland Swanson et al; Academic Medicine. 2005;80(10):S93-S6. Tarrant & Ware; Nurse Education Today. 2010;30(6):539-43.
  10. 10. Stem / vignette Question (Lead-in) Options Single Best Answer Jane Holland
  11. 11. MCQ stimulus formats  Context -free  Tests factual knowledge  Context-rich  Tests reasoning or application Schuwirth: Med Educ. 2004 Sep;38(9):974-9. Kennedy, 2007 Jane Holland Creating Evaluating Analysing Applying Understanding Remembering
  12. 12. NBME Manual p 35 - 49 Q. Which dermatome is at the umbilicus? A. T6 B. T8 C. T10 D. T12 E. L2 Q. A 65-year-old librarian presents with skin lesions suggestive of a Herpes zoster infection affecting the dermatome which includes the skin of the umbilicus.  Which segmental spinal nerve is associated with that dermatome? Jane Holland
  13. 13. Q. A 6 year old boy is admitted with a history of colicky abdominal pain which has now localised to his right iliac fossa.  The initial, visceral pain felt with appendicitis is referred along sympathetic fibres from which level of the spinal cord? A. T6 B. T8 C. T10 D. T12 E. L2 NBME Manual p 35 - 49 Jane Holland
  14. 14. Stem Lead-in Options  Clinical (or contextual) vignette • Age / gender • Presenting Problem / history • Examination findings / test results  Which of the following is the most: • Likely diagnosis • Appropriate treatment  Homogenous • One correct & 4 distractors • Alphabetical (or logical) order • All plausible & same length (short!) NBME Manual p 35 - 49 Jane Holland
  15. 15. Q. Which of the following Moodle activities allows participants to select a single option from a list? A. Checklist B. Choice C. Forum D. Survey E. Workshop Jane Holland
  16. 16. Q. Gavin is running a conference, at which there will be a number of parallel workshops with limited places. Which of the following Moodle activities could he use to allow participants to preselect their preferred workshop? A. Checklist B. Choice C. Forum D. Survey E. Workshop Jane Holland
  17. 17. Q. Which of the following Moodle activities allows participants to select one choice from a list of options? Word repeats Jane Holland A. Checklist B. Choice C. Forum D. Survey E. Workshop
  18. 18. Grammatical clues Long correct answer Absolutes Word repeats Logical cues Convergence Technical Item flaws NBME Manual p 19 - 27 Jane Holland
  19. 19. Q. Which of the following Moodle activities allows participants to select one choice from a list of options? Word repeats Jane Holland A. Checklist B. Choice C. Forum D. Survey E. Workshop
  20. 20. Q. It is extremely important for teachers to maintain a healthy diet. Therefore, students should always give them an: A. Apple B. Banana C. Bread roll D. Chocolate bar E. Mohito Grammatical clues Jane Holland a / an plural / singular
  21. 21. Q. A 76 year old diabetic is brought into the accident and emergency department with suspected diabetic ketoacidosis. After confirming that she is hyperglycaemic, the first step in management should be intravenous administration of: A. Chest X-ray B. Electrocardiogram C. Fasting blood glucose level D. Insulin E. Placement of an nasogastric tube Grammatical clues Jane Holland
  22. 22. Word repeats Q. A 58 year old man with a history of heavy alcohol use and previous psychiatric hospitalisation is confused and agitated. He speaks of experiencing the world as unreal. This symptom is called: A. Depersonalisation B. Derailment C. Derealisation D. Focal memory deficit E. Signal anxiety Jane Holland
  23. 23. Logical clues Q. Crime is: A. Equally distributed among the social classes B. Overrepresented among the poor C. Overrepresented among the middle class & rich D. Primarily an indication of psychosocial maladjustment E. Reaching a plateau of tolerability for the nation Jane Holland Also be wary of overlapping numericals...
  24. 24. Convergence Strategy Q. Local anaesthetics are most effective in the: A. Anionic form, acting from inside the nerve membrane B. Cationic form, acting from inside the nerve membrane C. Cationic form, acting from outside the nerve membrane D. Uncharged form, acting from inside the nerve membrane E. Uncharged form, acting from outside the nerve membrane Jane Holland
  25. 25. Long correct answer Q. Secondary gain is: A. Synonymous with malingering B. A frequent problem in OCD C. A complication of a variety of illnesses and tends to prolong many of them D. Never seen in organic brain damage Jane Holland
  26. 26. Absolutes... Q. Which of the following shoes are never worn by men? A. Boots B. Runners C. Sandals D. Stilettos E. Wellies Jane Holland
  27. 27. Absolutes Holsgrove G, Medical Education 1998; 32: 343 - 350 Jane Holland 0 10 20 30 40 50 60 0% 1% 5% “Never” 0 10 20 30 40 50 60 80% 95% 99% 100% “Always”
  28. 28. Jane Holland
  29. 29.  Shape  Long vignette & stem  short options  Cover test • Ideally can know the correct answer before seeing the possible options  Use homogenous distracters • i.e. all arteries, all medications, all diagnoses • Grammatically consistent • Logically compatible • List in logical or alphabetical order  Don’t use vague frequency terms  Never use absolutes!  Do not write a negative question!! NBME Manual p 35 - 49 Some useful principles Jane Holland
  30. 30. Jane Holland
  31. 31. Difficulty Discrimination Corrected Point Biserial Distractor Choice Introduction to Item Analysis  Classical Test Theory  Item Response Theory (IRT)  Generalizability Theory (G-Theory) Richard Arnett De Champlain: Med Educ. 2010; 44:109-117.
  32. 32.  How did the items / questions perform?? 1. What proportion of candidates got the question correct? 2. Which options were chosen most frequently? 3. Which options were chosen by low, medium and high performers on the test as a whole? 4. How did success on an item correlate with overall test score? Jane Holland Difficulty Discrimination Corrected Point Biserial Distractor Choice De Champlain: Med Educ. 2010; 44:109-117.
  33. 33. Item difficulty (DIF) – or facility  What proportion of candidates got the question correct? 90% of candidates answered correctly  DIF = 0.90  < 0.40 – hard  > 0.80 – easy  0.40 – 0.80 – good question  0.45 – 0.55 are extremely discriminating Jane Holland
  34. 34. Which options were chosen most frequently?  Distractor choice  Examine the proportion of candidates choosing each option  ALL options should be chosen by candidates  Replace any options not chosen Jane Holland
  35. 35. Discriminating Index (or power)  Which options were chosen by low, medium and high performers on the test as a whole? Lower 27% Upper 27%Middle  L N U U – L N = DI  Ideally, DP should be > 0.40 Jane Holland
  36. 36. Jane Holland
  37. 37. Richard Arnett
  38. 38. Additional measures of Discrimination  Point biserial correlation (RPB)  Equivalent to Pearson correlation co-efficient  Is a measure of association between a binary (nominal) variable and a continuous variable  Corrected point biserial correlation (CRPB)  The item is removed from the test total prior to calculation  Range = -1 to +1  >0.2 good, <0.2 weak  Negative – inverse relationship!!!! Jane Holland
  39. 39. Jane Holland
  40. 40. Jane Holland
  41. 41. Jane Holland
  42. 42. Moodle Quiz statistics  Item Difficulty... Jane Holland  In a quiz with random questions...  Position of items within the test may change  Therefore, analyses must distinguish between positions in the test, and test items  Students may answer different sets of questions  i.e. Answer 30 out of 50 possible questions from the bank Np N
  43. 43.  Click on the quiz, then access:  Administration  Quiz administration  Results  Statistics Jane Holland
  44. 44. Jane Holland
  45. 45. Jane Holland
  46. 46. Jane Holland
  47. 47. Good Stats Good Questions Good stats don’t necessarily mean good questions and good questions don’t always get good stats... ...but it is a good place to start Richard Arnett
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