All test questions (items) for the examination are multiple choice, with four choices, only one of which is correct. Items must be based on the test content outline.

Each multiple choice item is composed of a stem, followed by four options; one correct option and three distracters.  Example:

            Stem                                       Who invented the light bulb?

            Correct option                         1. Thomas Alva Edison

            Distracter                                2.  Benjamin Franklin

            Distracter                                3.  Alexander Graham Bell

            Distracter                                4.  Leonardo da Vinci

The stem may also be in the form of an incomplete sentence.  Example:

            Stem                                       The light bulb was invented by:

            Correction option                    1. Thomas Alva Edison.

            Distracter                                2.  Benjamin Franklin.

            Distracter                                3.  Alexander Graham Bell.

            Distracter                                4.  Leonardo da Vinci.

Characteristics of a good stem are:

            ● It presents a problem situation clearly

            ● It is stated positively rather than negatively

            ● It avoids the use of the pronouns “it,” “he,” “she,” and “you.”

            ● It is presented as simply as possible, including only information that is

               necessary to understand the problem

            ● It includes any words that would have to be repeated in each option

            ● It specifies the authority or standard upon which the correct option is

               based, if the item calls for a judgment

            ● It poses a problem to which the correct answer is not likely to change

               over time

            ● It focuses on important learning objectives and avoids testing trivia

Characteristics of good options are:

            ● Correct options are unquestionably correct and distracters are unquestionably wrong

            ● All four options are grammatically related to the stem

            ● The four options are homogeneous in terms of structure as well as content

            ● The correct option is similar in length to the distracters

            ● Absolute terms have been avoided (do not contain words like “all,” “none,” “always,” and “never”)

            ● Options are mutually exclusive

            ● Do not use “none of the above” or “all of the above”

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