This manual was written to help faculty members improve the quality of the multiple-choice questions written for their exam- inations. The manual provides an overview of item formats, concentrating on the traditional one-best-answer and matching formats. It reviews issues related to technical item flaws and issues related to item content. The manual also provides basic information to help faculty review statistical indices of item quality after test administration. An overview of standard-set- ting techniques is also provided. Issues related to exam blueprinting are not addressed in any detail. We have focused almost exclusively on the item level, leaving exam level planning for another manuscript. We anticipate that this manual will be useful primarily by faculty who are teaching medical students in basic science cours- es and clinical clerkships. The examples focus on undergraduate medical education, though the general approach to item writing may be useful for assessing examinees at other levels. This manual reflects lessons that we have learned in developing items and tests over the past 20 years. During this period, we have reviewed (quite literally) tens of thousands of multiple-choice questions and have conducted item-writing workshops for thousands of item writers preparing USMLE, NBME, and specialty board examinations as well as faculty at more than 60 medical schools developing test questions for their own examinations. Each workshop attendee has helped us to frame our thoughts regarding how to write better quality test questions, and, over the years, we have become better able (we believe) to articulate the whys and wherefores. We hope this manual helps to communicate these thoughts.
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