MCQs in MEDICAL EDUCATION

1. Dr. A. Precilla Catherine., MD
Faculty
MEU, Stanley Medical College
MULTIPLE CHOICE QUESTIONS

2. CHOOSE THE BEST RESPONSE
• The most important factor which decides whether a
student becomes a doctor is
a) MCQs ( NEET )
b) He has Money
c) Both of the above
d) None of the above
• Is the above MCQ framed correctly ?

4. SPECIFIC LEARNING OBJECTIVES
• At the end of this session, the participant should be
able to
– Decide When and How to use Multiple Choice
Questions as a method of Assessment
– Frame a Correct and Appropriate type of Multiple Choice
Question for any given Specific Learning Objective

5. ADVANTAGES OF MCQs
• Scoring is OBJECTIVE and RELIABLE
• NO ‘Halo’ Effect
• Rapidly marked and easy to grade (Computerised)
• Ideal for assessing large number of candidates
• Can test broad range of a given course
• ITEM BANK can be created
• Stems can be used to help Focus on the ‘Must-Know’ areas

6. DISADVANTAGES OF MCQs
• Time Consuming and Difficult to construct good questions
• NOT suitable to assess ‘Shows how’ and ‘Does’
competencies of Miller’s pyramid
• May NOT be the best way to test
Affective and Psychomotor
domains
• May encourage Guessing
• NO credit for partial information

7. BAD MCQ
GOOD MCQ
GROUP ACTIVITY - 1
Direction:
Frame a Multiple Choice Question ( MOCK MCQ )
( Use the White Board )

8. TERMINOLOGY
• ITEM
• ITEM SHEET
• ITEM BANK
• RESPONSE SHEET / ANSWER FORM

9. COMPONENTS OF A MCQ
• STEM
• OPTIONS
• DISTRACTORS
• KEY
• ( Direction )
• ( Theme & Lead – in Statement )

10. DIFFERENT FORMATS of MCQs-
HUBBARD and CLEMANS classification
• The ONE –BEST RESPONSE type ( Type A )
• MULTIPLE TRUE-FALSE COMPLETION type ( Type X )
• MULTIPLE RESPONSE type ( Type K )
• Simple MATCHING type ( Type B )
• RELATIONSHIP ANALYSIS type ( Type E )
• CASE CLUSTER type ( Type G )
• EXTENDED MATCHING QUESTION type ( Type R )

12. ONE – BEST RESPONSE Type
RECALL ( Non-vignette type )
DIRECTION:
Only ONE answer is correct. Tick the correct answer in the appropriate box in the answer sheet
provided
ITEM 1.
Which of the following mosquitoes transmits Dengue?
A. Aedes
B. Anopheles
C. Culex
D. Mansonoides
ANSWERS
1. A B C Dvv
STEM
OPTIONS
KEY
DISTRACTORS

13. ONE – BEST RESPONSE Type (Contd.,)
DIRECTION:
Only ONE answer is correct. Tick the correct answer in the appropriate box in the answer sheet
provided
ITEM 1.
A 10 year old boy is admitted with high grade fever and body ache. His platelet
count is decreasing since admission and is 15000/cu.mm at present . Peripheral
smear does not show any parasite. The physician suspects a mosquito borne viral
infection.
Which of the following is the likely mosquito involved ?
A. Aedes
B. Anopheles
C. Culex
D. Mansonoides
ANSWERS
1. A B C Dvv
PROBLEM SOLVING ( Clinical Vignette type )

14. Framing a Good MCQ
• ITEMS
– Decide on Number of MCQs for the given time & Fix the Pass level
– Do Content Analysis and Weightage Analysis based on Specific Learning
Objectives
– Decide on Number of questions from different formats/ Group them
together
– Items Should be factually Correct / Specific and of Appropriate Difficulty
Level
– Should NOT be Tricky / Trivial
– Give clear Directions and provide References
– Mention clearly if Guessing Correction is used

15. Framing a Good MCQ (Contd.,)
• STEM
– Should be Concise and Complete ( ‘COVER THE
OPTIONS’ RULE )
– Ask for the CORRECT answer, NOT the Wrong
answer
– Use ‘ NEVER / NOT / ALWAYS / USUALLY / SOMETIMES ’
Sparingly and with Caution
– DOUBLE NEGATIVES are forbidden
Avoid
CUES &
HINGING

18. Framing a Good MCQ (Contd.,)
• OPTIONS
– Increase the number of options to decrease Guessing
– Distractors should be Plausible / Homogenous
– Arranged in Logical Order and of Same Length
– Options should be Independent & Should NOT Overlap
– Should be Grammatically consistent with the Stem
– Avoid ‘ All of the Above’ & ‘None of the Above’
– Vary Position of the Correct Answer

21. GROUP ACTIVITY - 2
Directions:
Identify the Errors in the given MCQs and
Discuss ( Use Worksheet No. A )

23. MULTIPLE TRUE- FALSE COMPLETION Type
DIRECTION: Each of the options can be individually true or false and
are not interdependent. Circle the correct answer in the appropriate box
(True = T ; False = F )
ITEM 1.
Regarding Dengue Haemorrhagic Fever
A. Positive Torniquet Test is a feature
B. Haematocrit is Decreased
C. Progressive leukopenia is seen
D. Rapid Decrease in Platelet count usually precedes Plasma leakage
E. Pleural effusion and Ascites may be present
ANSWERS
1. A B C D E Credit
T F T F FT FT FT 5
Marking Pattern
5 All Correct
4 4 Correct
3 3 Correct
2 2 Correct
1 1 Correct

24. DIRECTION : Circle the correct answer in the appropriate space based on the code given
below.
ITEM I.
Regarding Dengue Haemorrhagic Fever
1. Positive Torniquet Test is a feature
2. Progressive leukopenia is seen
3. Rapid Decrease in Platelet count usually precedes Plasma leakage
4. Haematocrit is Decreased
ANSWERS
I. A B C D E
MULTIPLE RESPONSE type
A B C D E
Only 1, 2, 3
correct
Only 1, 3
correct
Only 2, 4
correct
Only 4
correct
All
correct

25. Simple MATCHING type
DIRECTIONS:
•Each set of matching questions consists of a list of 3 to 5 numbered items and several lettered
options. For each numbered item, select the ONE lettered option that best matches it. Fill the
square with the corresponding letter on answer sheet.
•Each lettered option may be selected once, more than once, or not at all.
ITEM I.
Match the following Diseases with the Vector transmitting them
ANSWERS
I. 1. 2. 3. 4.D C C D
1. Bancroftian Filariasis A. Anopheles Stephensi
2. Rift Valley Fever B. Anopheles Culcifacies
3. Dengue C. Aedes
4. Japanese Encephalitis D. Culex
E. Mansonoides

26. Answer Assertion Reason Relationship
A. True True The Reason is a correct explanation
B. True True The Reason is NOT a correct explanation
C. True False
D. False True
E. False False
Assertion Reason
1. Abnormal Haemostasis is
a manifestation of Dengue
Haemorrhagic Fever
BECAUSE Marked thrombocypenia is a
feature of Dengue
Haemorrhagic Fever
RELATIONSHIP ANALYSIS type
A B C D E
DIRECTION : Only ONE answer is correct. Circle the correct option in the appropriate box.
ITEM
ANSWERS
I.

27. DIRECTION:
• Only ONE answer is correct for each item. Tick the correct answer in the appropriate box
THE CASE . A 10 year old boy is admitted with high grade fever and body ache. His
platelet count is decreasing since admission and is 15000/cu.mm at present . Peripheral
smear does not show any parasite. The physician suspects mosquito borne disease.
ANSWERS
ITEM I.
Which is the mosquito
which is most likely
involved ?
A. Anopheles
B. Aedes
C. Culex
D. Mansonia
CASE CLUSTER Type
ITEM III.
Which one of the following is an
indicationfor platelet transfusion in
this patient ?
A. Platelets < 10,000/cu.mm
B. . Platelets >10,000/cu.mm but <
50,000/cu.mm
C. . Platelets > 50,000/cu.mm but <
1,00,000/ cu.mm
D. . Platelets > 1,00,000/cu.mm
ITEM II.
Laboratory Studies are most
likely to show
A. Increase in Hematocrit
B. Decrease in Hematocrit
C. No change in Hematocrit
D. Progressive Leukocytosis
ITEM I. A B C D
ITEM II. A B C D
ITEM III. A B C D

28. A. Idiopathic Thrombocytopenic Purpura E. Scurvy
B. Christmas Disease F. Vitamin K Deficiency
C. Dengue G. Anticoagulant toxicity
D. Von Willebrand s Disease H. Disseminated Intravascular Coagulation
Extended MATCHING Question Type
I. A B C D E F G H
II. A B C D E F G H
DIRECTION:
• For each patient with Altered Hemostasis, select the most likely diagnosis
• Only ONE answer is correct for each stem
• Each option may be used once, more than once or not at all
THEME : ALTERED HEMOSTASIS Options
Lead - In Statement : For each of the following clinical scenarios , select the most likely
diagnosis
STEMS :
I. A 10 year old boy is admitted with high grade fever and body ache. His platelet count is
decreasing since admission and is 15000/cu.mm at present . Torniquet test is positive.
Peripheral smear does not show any parasite.
II. A 70 year old male presents to the Medicine OPD with Bleeding gums and Easy
Bruisability. He is living alone for the past 3 months and consumes only canned
food.
ANSWERS

29. MCQ Format Time Required
For Each Item
ONE BEST RESPONSE type 40 seconds
MULTIPLE TRUE/ FALSE type 50 seconds
RELATIONSHIP ANALYSIS type 50 seconds
MULTIPLE RESPONSE type 50 seconds
CASE ANALYSIS type ( 3 MCQs ) 120 seconds
EXTENDED MATCHING type ( 5 stems ) 150 seconds

30. GROUP ACTIVITY - 3
Directions:
Identify the Format in which the given MCQs
Fit –in ( Use Worksheet No. B )

31. MCQ Format : ……………………………………………………………………………
Directions to student:
The MCQ Item:
Reference :
Item key A B C D E
Content Analysis for MBBS: Must know Good to know Nice to know
GROUP ACTIVITY - 4
Directions: Formulate MCQs in different formats varying the learning levels.

32. VALIDATION of MCQs
ITEM ANALYSIS
• Discrimination Index
• Facility Index
( Measures Item
Difficulty )
• Distractor
Effectiveness
PRE & POST VALIDATION
• Reliability
• Validity
• Feasibility ( Resource
Intensiveness )

33. MCQ ITEM NUMBER -
MCQ ITEM ANALYSIS
Date of Test FI DI
Distractor Effectiveness
A B C D E

35. SPECIFIC LEARNING OBJECTIVES
• At the end of this session, the participant should be
able to
– Decide When and How to use Multiple Choice
Questions as a method of Assessment
– Frame a Correct and Appropriate type of Multiple Choice
Question for any given Specific Learning Objective

36. FEEDBACK
DIRECTION:
Only ONE answer is correct. Tick the correct answer in the appropriate box in the answer sheet
provided
ITEM 1.
Did you understand what was discussed in this session?
A. B.
.
C. D.
ANSWERS
1. A B C Dvv