ERA-ASSESSMENT_OF_KNOWLEDGE-16-12-14.PPT

ASSESSMENT OF
KNOWLEDGE
Multiple Choice
Question
Dr. Eqbal Anwer
Assistant Professor,
Deptt. of Physiology, ELMCH

LEARNING OBJECTIVES
 What is MCQs?
 Parts of MCQs?
 Importance, Advantage & Limitations of
MCQs?
 Where to use these MCQs?
 How to construct MCQs?

What is Assessment?
The process of finding out how much each student
knows or can do.
1. Formative assessment (Diagnostic)
 Done during the course.
 Provide feedback to the student on his/her progress.
 Provide feedback to the teacher with data for
modification of his/her teaching.
2. Summative assessment (Certifying)
 Done at the end of period.
 For placing the student in order of merit.
 During giving any certificate.
2 TYPES

Why Assessment ???
 Ranking of student.
 Measurement of improvement in a student.
 To diagnose student difficulties.
 Evaluate method of teaching
 Motivate student to study.
CATEGORISE

GOOD ASSESSMENT
1. Validity
– Measuring what it tends to measure
2. Reliability
– Reproducibility
3. Acceptability
– Acceptability by students/assessor
4. Consequences of Assessment
– Educational Impact

What to Assess?
Domain Of Learning
&
How Often?

Bloom’s Taxonomy
1. Cognitive Domain
 Knowledge
2. Psychomotor Domain
 Practical Skills
3. Affective Domain
 Attitudes

LEARNING COMPONENTS
Communication skill
Psychomotor skill.
Clinical competence is demonstrated when a
task is performed using learned skills and
knowledge.
1. KNOWLEDGE Dose the student or doctor know
what he or she should do?
In practice, does the student or doctor
choose to do it when confronted with a
situation?
3. ATTITUDE/ RESPONSE
Is he or she able to do it?
2. SKILLS

MILLER’S PYRAMID
Knows
Knows How
Shows How
Does
CLINICAL COMPETENCE

METHODS USED FOR THE ASSESSMENT
OF MEDICAL STUDENT
1. Long Essay Questions LEQ.
2. Oral Examination.
3. Short Essay Questions SEQ.
4. Multiple Choice Question MCQ.
5. Modified Essay Question MEQ.
6. Patient Management Problem PMP.
7. Observational Assessment, OSCE, OSPE.

MULTIPLE CHOICE QUESTIONS
(MCQ)
 In these Question, you have to choose “
one-best answer” from multiple choices.
 Questions = Items

Anatomy of an ITEM
• Given a problem – Stem
• Followed by single question - Lead – in
• Option / Choices –
– Correct answer – Key
– Other incorrect Answers- Distracters

Example
Q. A 1-year-old infant is known to
have heart disease and is noted to
be cyanosed.
Which of the following is the most
likely diagnosis?
a. Atrial septal defect
b. Patent Ductus Arteriosus
c. Ventricular septal defect
d. Tricuspid atresia

Q. A 1-year-old infant is known
to have heart disease and is
noted to be cyanosed.
Which of the following is the
most likely diagnosis?
b. Patent Ductus
Arteriosus
c. Ventricular septal
defect
Example
LEAD - IN
STEM
DISTRACTOR
KEY

Importance of MCQ
 An ability to sample a wide range of
knowledge.
 Easy to administer
 to large numbers of students
 in a short period of time and
 minimal human intervention
 Highly Acceptable – preferred tool for
written assessment across most of the
academic disciplines.

Advantages
MULTIPLE-CHOICE ITEMS can provide:
 Versatility in measuring all levels of cognitive ability,
 Highly Reliable test scores,
 Scoring Efficiency and Accuracy,
 Objective measurement of achievement or ability,
 Wide sampling of content or objectives,
 Reduced guessing factor compared with true-false items, and
 Different response alternatives which can provide diagnostic
feedback.
(Ory & Ryan, 1993)

Limitations
 Are difficult and time-consuming to construct,
 Place a high degree of dependence on the
student’s reading ability and instructor’s writing
ability, and
 Are particularly subject to clueing. (Students
can often deduce the correct response by
elimination.) – need plausible distractor
 Attention to security of Question paper
(Ory & Ryan, 1993)

When to Use
 To test a variety of levels of learning
 When you have a large number of individuals
taking the test
 When you have time to construct the test items
 When time is limited for scoring
 When it is not important to determine, how well
individuals can formulate their own answer
 When you want to prepare individuals for future
assessments, that use a similar format (Clegg & Cashin, 1986)

Multiple-choice Test Construction
“… the greater your experience in their
construction, the longer it takes per
[multiple-choice] item to construct a
reasonably fair, accurate, and inclusive
question.”
- Wilbert J. McKeachie

Initial focus
 Standard / Scope of the examination
conducted
 Number of question – time available for
examination
 Source of Question

General guidelines
 Pre – plan well
 Best time when you teach
 Peer review/ peer validation
 More critical review – more you gain
 Trial run
 You‘ll determine facility index & discriminative
index

General Rules
 Each item should be based on an important
learning objective
 Test for significant/important information
 Focus on single idea in single test item
 Use items to assess higher order of thinking
 Keep language simple

Components
Stem: presents the problem
Correct or keyed options: correct option
Distractor options: incorrect options
(Clegg & Cashin, 1986)

Developing an Item
1. Choose an important concept
2. Write the stem
3. Write the correct answer (key)
4. Develop distractors
 common misconceptions
 errors that could be made
 plausible, yet less important information
 similar in style, length to the key
 every distractor should be reasonable (Clegg & Cashin, 1986)

Issues Related to Test-wiseness
• Grammatical Cues
• Logical Cues
• Absolute Terms
• Long Correct answer
• Word Repeats

Issues Related to Irrelevant Difficulty
• Options long
• Numeric data not stated consistently
• Vague terms
• Language not parallel
• Options in no logical order
• “none of the above” is used
• Stems tricky or unnecessarily complicated
• Answer to an item is “hinged” to the answer of a related
item (Clegg & Cashin, 1986)

Writing Items
• Write items on significant concepts, not
trivial facts.
• Write items that have a definite answer.
• Communicate clearly.
• Don’t give away the answer by including
irrelevant cues in the item.
• Don’t write items that require skills or
knowledge irrelevant to what you are
trying to measure.
• Have items reviewed by knowledgeable
persons other than the composer of the
question if possible.

Writing Stems
• Ensure that the directions in the stem are
very clear.(examinee should know exactly
what is being asked)
 Include the central idea in the stem instead
of the choices.
 Avoid window dressing (excessive verbiage).
 Word the stem positively, avoid negatives
such as NOT or EXCEPT. If negative words
are used, use the word cautiously and always
ensure that the word appears capitalized and
boldface.
(Haladyna, Downing & Rodriguez, 2002)

Writing Stem
 Avoid very short stems
 Write stem in either question form or
clinical scenario but only relevant text
 Clinical scenario is better than
statement as this stimulate higher level
of thinking

Writing Stems
Better:
Q. Which of the following is true
about the middle adult years?
A. It encompasses ages 19 to 30.
B. It is the most conflict-free period
of life.
C. It is characterized by dramatic
changes in our sense of values.
D. It is marked by a conflict between
intimacy and isolation.
Q. According to Erickson, the
middle adult years are
characterized by the conflict
between ____ and ___ .
A. intimacy; isolation
B. generativity; stagnation
C. integrity; despair
D. industry; despondency
(Ory & Ryan, 1993)
Avoid stems that ask for a series of multiple true-false responses.

Writing Stems
Better:
Q. Sheldon developed a highly
controversial theory of personality
based on body type and temperament
of the individual. Which of the following
is a criticism of Sheldon’s theory?
A. He was influenced too much by
Freudian psychoanalysis.
B. His ratings of physique and
temperament were not independent.
C. He failed to use an empirical
approach.
D. His research sample was improperly
selected.
Q. Which of the following
is a criticism of Sheldon's
theory of personality?
(Ory & Ryan, 1993)
Eliminate excessive wording and irrelevant information.

Writing Stems
Better:
Q. The receptors for the
vestibular sense are located
A. in the fovea.
B. in the brain.
C. in the middle ear.
D. in the inner ear.
Q. The receptors for the
vestibular sense are located in
the
A. fovea.
B. brain.
C. middle ear.
D. the inner ear.
(Ory & Ryan, 1993)
Include in the stem any word(s) that might otherwise be
repeated in each alternative.

Writing Stems
Q. Which is not a major
technique for studying brain
function?
A. accident and injury
B. cutting and removing
C. electrical stimulation
D. direct phrenology
Q. Which is NOT a major
technique for studying
brain function?
A. accident and injury
B. cutting and removing
C. electrical stimulation
D. direct phrenology
(Ory & Ryan, 1993)
Use negatively stated stems sparingly.
When used, underline and/or capitalize the negative word.
Better:

Writing Stems
Q. ___ is the least severe
form of behavior disorder.
A. Psychosis
B. Panic disorder
C. Neurasthenia
D. Neurosis
Q. The least severe form of
behavior disorder is ___ .
A. Psychosis
B. Panic disorder
C. Neurasthenia
D. Neurosis
(Ory & Ryan, 1993)
When using incomplete statements avoid beginning with the
blank space.
Better:

Writing Stems
Q. According to Freud the
raison d’être for hysteria
was
A. sexual conflicts.
B. unresolved feelings of
guilt.
C. latent tendencies.
D. repressed fear.
Q. According to Freud
hysteria was caused by
A. sexual conflicts.
B. unresolved feelings of
guilt.
C. latent tendencies.
D. repressed fear.
(Ory & Ryan, 1993)
Use familiar language.
Better:

Writing Stems
Better:
Q. How many interrelated
stages to creative problem
solving are there?
A. Three
B. Four
C. Seven
D. Ten
Q. The textbook indicates that
there are ___ interrelated
stages to creative problem
solving.
A. Three
B. Four
C. Seven
D. Ten
(Ory & Ryan, 1993)
Provide sufficient information in the stem to allow students
to respond to the question.

Writing Options
 Develop as many effective choices as you
can, but research suggests three is
adequate.
 Make sure that only one of these choices is
the right answer.
 Vary the location of the right answer
according to the number of choices
 Place choices in logical or numerical order.
 Keep choices independent; choices should
not be overlapping.

Writing Options
 Keep choices homogeneous in content and grammatical
structure.
 Keep the length of the choices about equal.
 None-of-the-above should be used carefully.
 Avoid All-of-the-above.
 Make all distractors plausible.
 Use typical errors of students to write your distractors.
 Use humor if it is compatible with the teacher and the learning
environment.

Writing Options
 Phrase choices positively; avoid negatives
such as NOT.
 Avoid giving clues to the right answer, such
as:
o specific determiners including always, never, completely,
and absolutely.
o clang associations, choices identical to or resembling
words in the stem.
o Very noticeable correct choice.
o pairs or triplets of options that clue the test-taker to the
correct choice.
o blatantly absurd, ridiculous options.

Writing Options
Q. Which of the following does
not belong with the others?
A. Wundt
B. Structuralism
C. James
D. Titchener
(Ory & Ryan, 1993)
Make sure there is one correct or best response.

Writing Options
Q. The number of photoreceptors in
the retina of each human eye is about
A. 1000,000.
B. 2 million.
C. 115 million.
D. 2.37 billion.
Better:
A. 5 million.
B. 35 million.
C. 65 million.
D. 115 million.
(Ory & Ryan, 1993)
Make all alternatives plausible and equally attractive to both
less-knowledgeable and skillful students.

Writing Options
Q. Problem representation
involves
A. determining which factor
matters and which do not.
B. the initial state of problem
solving.
C. both a and b.
D. neither a nor b.
Better:
A. determining which
factors matter and which
do not.
B. the initial state of
problem solving.
C. reducing the problem to
manageable segments.
D. all of the above.
(Ory & Ryan, 1993)
Minimize the use of the all-of –the-above and none-of-the-above
alternatives.

Writing Options
Better:
Latane and Darley smoke-filled
room experiment suggested that
people are less likely to help in
groups than alone, because
people
A. in groups talk to one another.
B. who are alone are more attentive.
C. in groups do not display pluralistic
ignorance.
D. in groups allow others to define
the situation as a non-emergency.
Latane and Darley smoke-filled room
experiment suggested that people are
less likely to help in groups than
alone, because people
A. talk to one another.
B. are less attentive than people
who are alone .
C. do not display pluralistic
ignorance.
D. allow others to define the
situation as a non-emergency
(Ory & Ryan, 1993)
All alternatives should be approximately equal in length.

Writing Item Options
Which of the following is
NOT a defense
mechanism?
A. Conflict.
B. Repression.
C. Reaction formation.
D. Rationalization.
Better:
A. Rationalization.
B. Repression.
C. Reaction formation.
D. Regression.
(Ory & Ryan, 1993)
Make alternatives parallel in construction and consistent
with the stem.

Q. In the course of a dark
adaptation , the eye’s best
sensitivity to wavelength
shifts to
A. 580 millimicrons.
B. 477 millimicrons.
C. 505 millimicrons.
D. 600 millimicrons.
Better:
A. 600 millimicrons.
B. 580 millimicrons.
C. 505 millimicrons.
D. 477millimicrons.
(Ory & Ryan, 1993)
When possible, present alternatives in some logical order
(e.g. most to least and chronological)

Q. Rods are found in the
A. blind spot.
B. fovea.
C. periphery of the retina.
D. back of the eye.
Better:
A. blind spot.
B. periphery of the fovea.
C. periphery of the retina.
D. cornea.
(Ory & Ryan, 1993)
Make the alternatives mutually exclusive.

Flooding differs from systematic
desensitization in that
A. the former is based on classical
conditioning and the latter on operant
conditioning.
B. systematic desensitization requires
insight and the flooding does not.
C. flooding has you start at the top of your
fear hierarchy and systematic
desensitization has you start at the
bottom and work up gradually.
D. flooding emphasizes the use of
cognitions to a much greater extent
than does systematic desensitization.
Better:
Flooding differs from systematic
desensitization in that flooding
A. is based on classical
conditioning rather than
operant conditioning.
B. doesn’t require insight.
C. starts at the top of the fear
hierarchy.
D. places greater emphasis on the
use of cognitions.
(Ory & Ryan, 1993)
Avoid overly wordy alternatives that become confusing
and difficult to read.

Q. School psychologists who
examine and place children in
special education settings often
apply the research done by
A. biopsychologists.
B. educational psychologists.
C. clinical psychologists.
D. counseling psychologists.
Better:
School psychologists often
apply the research done by
(Ory & Ryan, 1993)
Avoid irrelevant cues such as grammatical structure,
well-known work associations, or connections
between the stem and the correct answer.

Writing Options
Q. Which of the following is a
characteristic of persons with
Down’s syndrome?
A. Larger than normal head
B. Obesity
C. Oriental-like skin folds over
the eyes
D. Above average height.
Better:
A. Larger than normal head
B. Obesity
C. Downward sloping skin
fold over the eyes
D. Above average height.
(Ory & Ryan, 1993)
Avoid language that may offend or exclude a particular group of
individuals.

For developing options
 Place option in logical/ numerical
sequence
 Use letters in front of options
 Keep options independent – mutually
exclusive
 Keep content of all options
homogeneous
 Keep length of option nearly equal
 Phrase the options positively

Rules for Key
 One and only one
 Balanced – in a set of items, position of
correct option should same no. of times
for each position

Rules for Distracter
 Plausible – more similar to correct answer
 No too closer to correct answer – lead to
test for precision

AVOID
 Cueing one items with another
 Tricky items that mislead examinees
 Items based on assumptions
 Negative phrasing
 Providing clues – grammatical / making
correct answer longer
 Use of never/ always
 None of the above/ all of the above

Tips for Writing Tests
• Compose test items over time.
• Test what you really want individuals to
learn.
• Check borrowed items carefully.
• Create a test bank.
• Start easy to build confidence.
• Get feedback on items.
(Nilson, 2010)

Planning a Test
 Use a test matrix or blueprint.
 Identify major ideas and skills
rather than specific details.
 Use Bloom’s cognitive taxonomy
or something appropriate for
your context.
(Nilson, 2010)

Bloom’s Cognitive Domain
Knowledge
Comprehension
Application
Analysis
Synthesis
Evaluation

Objectives at Different Levels
Q. What is the average effective radiation
dose from chest CT?
A. 1 mSv
B. 8 mSv
C. 16 mSv
D. 24 mSv
Level: Knowledge
Objective: State the average effective radiation dose from
chest CT.

Q. A patient is 54 yr male who looks weak &
confused. We suspect it to be diabetes mellitus
Which of the sign & symptom serve best to
confirm diagnosis
A. Poor skin turgor with tenting
B. Recent decrease in appetite
C. Increase thirst and urination
D. Unexplained bruising of the abdomen
Level: Comprehension
Objective: Knows the disease or not

Q. A 72-yr male who had several attacks of
coronary disease is admitted to hospital for
gangrene of one leg and found on admission to
have sign & symptom of intestinal obstruction.
Which is the most probable cause of
obstruction?
A. Cancer of colon
B. Intussusceptions
C. Mesenteric Thrombosis
D. Volvulus
Level: Application
Objective: Apply knowledge of clinical feature for diagnosis

Q. A 68-yr female stuporous with respiratory
distress. O/E:
Pulse – 136/min, weak
Resp – 32/min with crackles
BP – 60 mm Hg Palpatory
Skin appears cool and diaphoretic. Capillary Refill
Time is significantly delayed
Which is the most probable cause?
A. Cardiogenic Shock
B. Neurogenic Shock
C. Hypovolumic Shock
D. Septic shock
Level: Analysis and Synthesis
Objective: Analyze data and synthesize the diagnosis

ITEM ANALYSIS
It is a statistical technique which is
used for selecting and rejecting the items
of the test on the basis of their difficulty
value and discriminated power
Important step in the development of any assessment strategy

 Item statistics are used to assess the
performance of individual test items
 Statistical method used –
1. Facility value – (item difficulty)
2. Discriminative index – (item discrimination)
3. Distractor efficiency

STEPS
1. Evaluate answer card - MARKING
2. Arrange marks list in descending order
3. Divide whole list into 2 half
 High achiever
 Low achiever
If list is bigger – divide upper 30%or25%
and lower 30%or25%

EXAMPLE
Total 100 a b c d
HAG(n=50) 0 02 08 40
LAG(n=50) 12 26 02 10
Q. A 1-year-old infant is known to have
heart disease and is noted to be
cyanosed.
Which of the following is the most likely
diagnosis?
b. Patent Ductus Arteriosus
c. Ventricular septal defect

1. Facility Value (F.V)
“The facility value of an item is defined as the
proportion or percentage of the examinees who
have answered the item correctly”
J.P. Guilford
Difficulty index

Calculation
FV =
No. of right answer (H + L)
N (Total no. of students)
X 100
Proportion of respondents selecting the right answer to that item
a b c d
HAG(n=50) 0 02 08 40
LAG(n=50) 12 26 02 10
40+10/100 = 50 %

RANGE
 FV ranges from 0 – 100%
 Low FV – too difficult Question
 High FV – too easy Question
Easy – ≥ 85%
Medium – 51%-84%
Hard - ≤ 50

Significance
 Determine that students have learned the
concept
 Discriminate between students who knows
and who don’t
 Help in designing better paper
 Start test with easy (high FV) items
towards more difficult items (low FV)

2. Discrimination Index (D.I)
“It is the ability of an item to discriminate
between skilled and unskilled examinees”
- Blood and Budd(1972)

Calculation
DI =
2 x (H - L)
N
Helps to differentiate who are knowledgeable
a b c d
HAG(n=50) 0 02 08 40
LAG(n=50) 12 26 02 10
2x(40-10)/100 = 0.6

RANGE
 DI ranges from -> -1 to +1
 DI = 1 indicates item perfectly
discriminates between those who
knows from those who don’t
 Negative – either ambiguous question
or wrong key

RANGE
 Item with high DI are preferred
≥ 0.35 – GOOD
<0.2 – 0.35> – INTERMEDIATE
≤ 0.2 - UNACCEPTABLE

Significance
 Flaws in item can be identified
 Provide feedback for improvement
 Learning can be improved
 Misconception in learning can be identified

3. Distractor Efficiency
 Distractor should be PLAUSIBLE
 Any distractor that is not picked by at
least 5% of student – is not a good
distractor
a b c d
HAG(n=50) 0 02 08 40
LAG(n=50) 12 26 02 10
GOOD Change the distractor

QUESTION BANKING
 Large pool of question with set of
information regarding question
 Goal – ability to deposit, discover and
retrieve question

Information on Card
Content Area: Nerve Muscle Physiology
Chapter: 21 (Muscle Blood Flow During Exercise)
Item:
Stem : main cause of increased blood flow to exercising
muscles is
Options:
a. Raised BP
b. Vasodilatation due to local metabolite
c. Increased sympathetic discharge
d. Increased Heart Rate
Key: Vasodilatation due to local metabolite
Reference: Guyton physiology 11/e p 247
Side A

Year Class Q. No.
Options
FV DI
a b c d
2009 PGET 122 21 18 61 25 49 0.35
2010 PGET 135 11 16 72 13 64 0.29
2011 PGET 148 28 21 69 14 52 0.31
2012 PGET 133 25 15 78 08 62 0.25
Side B

ERA-ASSESSMENT_OF_KNOWLEDGE-16-12-14.PPT

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