Writing Questions for Learning and Assessment-Constructing Written Test Questions For the Basic and Clinical Sciences, 6th ed. (NBME, 2020)

Constructing Written Test Questions For the Basic and Clinical Sciences, 6th ed. (NBME, 2020)

Pdf Summary

The NBME Item-Writing Guide (November 2020) is a comprehensive manual designed to assist health sciences faculty in writing high-quality multiple-choice questions (MCQs) for examinations. It emphasizes the importance of assessment for aligning instruction with educational goals, motivating students, identifying deficiencies, and guiding instructional improvements. The guide outlines key principles for effective test development, including content sampling that accurately represents the domain and attention to psychometric properties such as item difficulty and discrimination.<br /><br />Two main MCQ formats are described: one-best-answer (single best response) and true-false (multiple true options). The manual strongly recommends one-best-answer items as they better assess clinical judgment and application of knowledge, reduce ambiguity, and prevent guessing. It provides detailed rules for writing these items, such as focusing on important concepts, assessing application rather than recall, using focused and clear lead-ins, and ensuring option homogeneity and plausibility.<br /><br />The guide discusses common technical item flaws that introduce irrelevant difficulty or cue savvy test-takers, including long or complex options, vague terms, negatively phrased lead-ins, grammatical cues, absolute terms, and convergence of answer content. Strategies to avoid these pitfalls are presented to enhance item fairness and validity.<br /><br />Item analysis techniques are explained for evaluating item difficulty (percent correct), discrimination (correlation of item performance with overall test scores), and option effectiveness, along with methods to compare performance across test-taker groups and over time. Examples illustrate interpretation of item statistics.<br /><br />For clinical and foundational science items, the manual urges using rich clinical vignettes with appropriate patient characteristics, emphasizing application of knowledge and avoidance of bias or stereotyping. Item sets like F-type (case-based sequential questions) and patient chart formats are discussed to mimic clinical reasoning processes.<br /><br />The guide highlights the integration of media—images, videos, audio, interactive avatars—to enhance authenticity and assess skills not captured by text alone while stressing patient confidentiality, accessibility (e.g., accommodations for disabilities), and minimizing distractions.<br /><br />Finally, the manual reviews retired NBME item formats, advocating exclusively for one-best-answer and related set formats for standardized, valid assessments. Extensive appendices provide quick references, sample lead-ins across competencies, examples, and resources on item writing and test development best practices. This guide serves as a vital resource for educators designing MCQs that validly and reliably measure health sciences knowledge and clinical competence.

Keywords

NBME Item-Writing Guide

multiple-choice questions

MCQ formats

one-best-answer items

test development principles

item analysis techniques

clinical vignettes

assessment validity

psychometric properties

health sciences education