This document provides information on creating a Table of Specifications (TOS) and guidelines for writing different types of assessment questions such as Multiple Choice Questions (MCQs) and Short Answer Questions (SAQs). It discusses what a TOS is and the steps to create one, including listing topics, assigning cognitive levels, and calculating percentages. It also outlines best practices for writing high-quality MCQs and SAQs that assess different levels of learning. The goal is to help instructors design valid and reliable assessments.

2. Setting Rules
No cross talks
Cell phone on silent
Hand raise if any question

3. TOS, MCQs, SAQs
Dr. Sindhu Almas
Lecturer Community Medicine
Department, LUMHS Jamshoro.

4. Table Of Specifications(TOS)?
It is a chart that contains information about:
 the topics of your specialty
 the level you want each topic to be taught , i.e.
whether you want a particular topic to be assessed at
C1, C2 or C3
 the total of these topics along with this total
expressed in percentage. (Note: the level at which
you assess should be similar to the level at which
something is taught).

5. How Do We Make It?
STEPS:
Make this table in a group.
This table has six columns. The number of rows depends on
the number of topics that you have.
.The top row contains the following headings: contents, C1,
C2 & C3, the total number of items, percent of items.

6. Table Of Specifications(tos)?
It is a chart that contains information about:
 the topics of your specialty
 the level you want each topic to be taught , i.e. whether
you want a particular topic to be assessed at C1, C2 or C3
 the total of these topics along with this total expressed in
percentage.( Note: the level at which you assess should be
similar to the level at which something is taught).

7. How Do We Make It?
STEPS:
Make this table in a group.
This table has six columns. The number of rows depends on
the number of topics that you have.
.The top row contains the following headings: contents, C1, C2
& C3, the total number of items, percent of items.

8. STEPS In Making TOS:
In the columns on the left you will enlist the
topics.
Under the columns of C1, C 2 & C3 you will
put the relative importance you want to give to
each topic.
It is always a better idea to fill in the total first
and then deal with the sub division later.

9. How Does One Decide Which Topic/ Unit To Give
More Importance
This depends on the priority and spread of
diseases in the country.
E.g. : In Pakistan the most prevalent disorder is
iron deficiency anemia or TB, then probably most
importance should be given to either ‘Blood’ or
‘Infectious diseases.

10. How Does One Decide Whether One Should Keep
More Of C1, C2 Or C3?
That depends on the level of
students you are dealing with.

11. TOS Or Blue Prints
CONTENTS COGNITIVE PSYCO-MOTOR AFFECTIVE ASSESS
TOOL
TOTAL
ITEMS
PERCENTAGE
Anemia
(20%)
Types of anemia Mcq 05
Hb estimation TOACS 01
counselling toacs 01

12. Multiple Choice Questions
The multiple choice type of test offers the student with
more than two options per item to choose from. Each
item in a multiple choice test consists of two parts: a)
the stem, and b) the options. In the set of options, there
is a “correct” or“ best” option while all the others are
considered “distracters”.

13. Types Of Mcqs
 True /False
 A type 4-5 options (single best MCQ)
 R type 8-10 options with 2-3 scenario(EMQ)
 E type Assertion & reasoning.
 Matching columns
 Sentence completion.
 Relationship analysis

14. Assignment
 Write a short note on following types of MCQs with examples
 R type
 E type

15. Advantage
Can cover broad range of content
Easily scored and graded
Measures a variety of levels of learning
When well-constructed, has proven to be an
effective assessment tool
Minimum of writing for students

16. Disadvantages
Difficult to come up with plausible
distracters/alternative responses
Construction of good items is time consuming
Measuring ability to organize and express ideas is
not possible

17. MULTIPLE TRUE/FALSE TYPE :
An initial statement (called stem) is followed by five completions (called
items). Each item must be correctly identified as either “TRUE” or
“FALSE”.
INSTRUCTION :
Mark either “T” for TRUE or “F” for FALSE for each item given below, or
shade the appropriate box for each correct answer in the response sheet
with the special pencil provided to you.

18. EXAMPLE :
Characteristic feature/s of “Cushing’s Syndrome” include
A. generalized obesity
B. hypertension
C. menorrhagia
D. proximal muscle weakness
E. osteoporosis
KEY : T :B,D,E F :A,C.
(it may be written in this form also)
A/F, B/T, C/F, D/T, E

19. Anatomy of Single-
Best MCQS

20. One Best answer type MCQ
Also called an item consist of
The STEM
Lead- in
OPTION LIST

21. Single-best MCQ
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:
captopril
digoxin
 phenytoin
propranolol
Quinidine*
STEM
LEAD-IN
DISTRACTERS
CORRECT
ANSWER
LEAD-IN
CORRECT ANSWER

23. “A Type “ Question
1. Stem
 Should include as much information as possible regarding the point of interest.
 Should be relatively long and should not contain any unwanted information.
 Should contain more than one data set.
 Should have a scenario ideally
2. Lead-in A question.
3.Options :
A. Distracter
 B. *(Key answer)
 C. Distracter
 D. Distracter

24. Options Or Distractors
Should be relatively short with no additional data than
the stem. Avoid long answer
Should be homologous
Arranged alphabetically
Of equal length
Should not give any clues
Plausible and real entities
Distractors similar to correct answer in length and
constructions
Numerical data are not stated consistently

25. General Guidelines For Item
Construction
Make sure the item can be answered without looking at the
options.(cover test)
Stems should be long and options short.
Avoid superfluous information.
Avoid grammatical cues. Stem should not give clue towards one or
more distractors
Avoid logical cues- a subset of the options are collectively
exhaustive.
Avoid convergence strategies. The correct answer includes most
letters in common with the stem

26. General Guidelines For Item
Construction
Avoid “tricky” and overly complex items.
Avoid using key word in stem
Avoid using absolutes such as always, never, and all in the
options; also avoid using vague terms such as usually and
frequently.
Avoid negatively phrased items (e.g., those with except)
Focus on important concepts; don’t waste time testing trivial
facts.

27. Problem Solving Mcqs
 Assess understanding by asking ‘ why’ or ‘ how’
to assess higher order learning objectives.
 Promote evaluation and synthesis skills by posing a
problem and provide solutions via a range of response
options.
 Restrict use of negatives in the question.
 Avoid ‘all of the above’ or ‘none of the above’

28. MCQs
SAQs
Breadth of knowledge
Depth of knowledge

30. SHORT ANSWER QUESTIONS
(SAQs)
Supply type item (a form of open-ended question)
with no cueing
Response restricted to point-wise answers
More objective as point-wise answers make
agreement on key easier

31. STEPS FOR WRITING Saqs
• Identify topic/concept that requires exploring of different aspects
such as diagnosis along with reasons to arrive to the diagnosis.
• Construct clinical vignette on the concept and link questions to the
vignette
• Frame 3-4 questions on specific tasks you want candidates to
perform
•
• Select appropriate wordings for each question

32. Example Of An SAQ
You are a medical officer in OBGY. You have been asked to review a 28
years old woman , para 2 who has presented with a 6 weeks’ amenorrhea
& slight vaginal bleeding. She is haemodynamically stable. Ultrasound
shows a complex right adnexal mass, 3x2 cms in size. There is no
pregnancy sac in the uterus.
Case Vignette
Exam: FCPS-II
Importance: Essential

33. Example No.1 of an SAQ (contd…)
Q1. What is the most likely diagnosis?
(2 marks)
Q2. Name three preliminary investigations you will like
to perform at this stage.
(3 marks)
Q3. What will be immediate steps in the management
of this patient? (5 marks)
Questions

34. Example No.1 Of An SAQ (Cont…)
Ans (1) Tubal pregnancy 2 marks
Ans (2) 3 preliminary investigations are:
Complete blood count
 Blood group and RH factor
 Serum B-HCG. 3 marks
Ans (3) lmmediate steps in management are:
 Save I/V line 5 marks
 Arrange two units of blood
Key

35. Assignment 2
Develop an MCQ with one best answer type
having the stem, lead- in and option list

37. References
 Norman GR, Van der Vleuten CPM, Newble DI (eds.) International Handbook of
Research in Medical Education. UK. Kluwer Academic Publishers; 2002. Chap. 20 ,
Assessment of Knowledge with Written Test Forms: pp.664-6