Question Writing

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Below are some tips and guidance for Invited Faculty participating in Interactive Sessions or any presentation wanting to use the Live Polling feature during IDWeek 2019™. These speakers will be using audience response questions during their presentations.

It is recommended that questions/answers be prepared relative to the level of complexity in your presentations as the participants’ knowledge will be measured while completing the assessment.

Quick Tips 

  • Yes/NoTrue/False, and None/Allof the Above responses are not acceptable responses for “One Best Answer” Questions

  • Be sure to review the Figures sectionto determine acceptable formats

  • It is a best practice to submit a rationale and reference with your questions. All questions require a rationale for the correct answer only; however, reference(s) should be submitted when appropriate.

  • Be sure to upload the required information into the designated fields(i.e., Stem = background information, Lead = the questions, etc.)


  • Videos are not accepted

  • JPG and PNG files are the only formats allowed

  • Image submitted must be at least 600 dpi for readability

  • Remove all protected health information/possible identifiers

  • Only one image per question is allowed (if you need to display more than one image, please be sure to combine them into only one file). Crop to show only what is needed; avoid all inessential complexes.

  • Remove extraneous indicators (i.e., arrows, circled complexes, etc.)

  • Essential elements should be very clear (i.e., stimulus artifacts, His potentials, etc.)

“One Best Answer” Questions

In contrast to true/false questions, one-best-answer (A-type) questions make explicit the number of options to be selected. A-type items are the most widely used multiple-choice-item format. They consist of a stem (e.g., a clinical case presentation) and a lead-in question, followed by a series of choices, typically one correct answer and four distractors. The following question describes a situation (in this instance, a patient) and asks the attendee to indicate the most likely cause of the problem.

A Good Example

A 32-year-old man has a 4-day history of progressive weakness in his extremities. He has been healthy except for an upper respiratory tract infection 10 days ago. His temperature is 37.8 C (100 F), blood pressure is 130/80 mm Hg, pulse is 94/min, and respirations are 42/min and shallow. He has symmetric weakness of both sides of the face and the proximal and distal muscles of the extremities. Sensation is intact. No deep tendon reflexes can be elicited; the plantar responses are flexor.

Which of the following is the most likely diagnosis?

Answer Options:
A. Acute disseminated encephalomyelitis
B. Guillain-Barré syndrome
C. Myasthenia gravis
D. Poliomyelitis
E. Polymyositis

Note that the incorrect options are not totally wrong. The options can be diagrammed as follows:

Even though the incorrect answers are not completely wrong, they are less correct than the “keyed answer.” The attendee is instructed to select the “most likely diagnosis”; experts would all agree that the most likely diagnosis is B; they would also agree that the other diagnoses are somewhat likely, but less likely than B. As long as the options can be laid out on a single continuum, in this case from “Most Likely Diagnosis” to “Least Likely Diagnosis,” options in one-best-answer questions do not have to be totally wrong.

A Poor Example

This item is flawed (below). After reading the stem, the attendee has only the vaguest idea what the question is about. In an attempt to determine the “best” answer, the attendees have to decide whether “it occurs frequently in women” is more or less true than “it is seldom associated with acute pain in a joint.” This is a comparison of apples and oranges. In order to rank-order the relative correctness of options, the options must differ on a single dimension or else all options must be absolutely 100% true or false.


Which of the following is true about pseudogout?
A. It occurs frequently in women.
B. It is seldom associated with acute pain in a joint.
C. It may be associated with a finding of chondrocalcinosis.
D. It is clearly hereditary in most cases.
E. It responds well to treatment with allopurinol.

The diagram of these options might look like this (below). The options are heterogeneous and deal with miscellaneous facts; they cannot be rank-ordered from least to most true along a single dimension. Although this question appears to assess knowledge of several different points, its inherent flaws preclude this. The question by itself is not clear; the item cannot be answered without looking at the options.

Reference:  Constructing Written Test Questions For the Basic and Clinical Sciences (3rd ed. Revised). (2002). Philadelphia, PA: National Board of Medical Examiners® (NBME®). Please refer to pages 16-18, “The One-Best-Answer Family.” 


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