Multiple Choice Questions ( MCQs)

1. Multiple Choice Questions(MCQs) Ensuring the question fits the purpose Julie Vuolo, Learning and Teaching Institute j.c.vuolo@herts.ac.uk

2. This workshop aims to cover Principles for good practice assessment Type of questions Advanced MCQs Further resources

3. Considerations when creating MCQs Pedagogical Good practice in Undergraduate Education Encourages contact between students and lecturers Develops reciprocity and cooperation among students Encourages active learning Gives prompt feedback Emphasises time on task Communicates high expectations Respects diverse talents (Chickeringand Gamson,1987) UH Assessment for Learning Principles • Engages students with the assessment criteria • Supports personalised learning • Ensures feedback leads to improvement • Focuses on student development • Stimulates dialogue • Considers student and staff effort (UH Knowledge Exchange, 2012)

4. Considerations when creating MCQsEffective vs. efficient assessment Waste of time Staff/Resource Efficiency (or 1/t) Educational Effectiveness

5. Bloom’s Taxonomy, revised by Anderson Nouns to verbs and the top two reversed

6. Types of MCQs • Simple • One correct answer • True/False • Multiple Response Questions • Multiple True/False • Matching items • Extended matching • Assertion Reason

7. Some examples…

8. The main stadium for the London Olympics in 2012 is located in: • Great Britain • British Isles • England • Scotland

9. Quintin McKellar who was previously VC at the Vet School joined the University in? • December 2010 • January 2011 • February 2011 • January 2020

10. MCQs • Are reliable • Are easy to mark • Are easy to produce • Can only be used to test the cognitive domain

11. Re-write the questions

12. True/False Two possible alternatives so fair chance of getting the right answer… Some tips: • Use statements which are unequivocally true or false. • Avoid lifting statements directly from assigned reading, lecture notes or other course materials so that recall alone will not permit a correct answer. • As in multiple choice questions generally, use negatives sparingly. • Generally avoid the use of words which would signal the correct response to the test-wise student. Absolutes such as “none”, “never”, “always”, “all”, “impossible” tend to be false, while qualifiers such as “usually”, “generally”, “sometimes” “often” are likely to be true. More usually used as a basis for more complex Assertion/Reason questions

13. Components of an MCQ Options +/- feedback

14. Stem • Considerations • Use clear, straight forward language • Aim to write as a complete sentence • Avoid use of unnecessary content • Avoid the use of negatives. If you must use them embolden them to make them stand out • Avoid giving clues in the question e.g. an/a • Avoid veering away from the content/cognitive level that you aimed to address

15. Options Correct answer and Distractors • Avoid repeating the same content in the options – move it to the stem if possible • Word distractors in a similar way to the correct answer and keep to similar length • Distractors should be plausible • Avoid ‘all of the above’/ ‘none of the above • Aim to use common misconceptions/student errors as distractors • There should be a sufficient number of distractors • A correct statement but not the answer to the question is a good distractor

16. Any questions?

17. Higher level of cognitive testing • Multiple Response Questions • Multiple True/False • Matching items • Extended matching • Assertion Reason • Marking gets more complex • Some forms can be used in EVS but not all • E.g. Confidence marking/Negative marking

18. Certainty-Based Marking Students rate their certainty on a scale of 1-3 CBM motivates reflection about the reliability and justification for each answer, since the student gains by identifying reasons either for reservation or confidence Maximum formative benefit requires immediate feedback, prompting reflection about uncertainties or confident errors

19. Why use CBM?  • To encourage them to really understand the issues, not just to react immediately to a question • To encourage students to think laterally: other pieces of knowledge may help to validate or question their answer • To challenge the students - if they won't risk losing marks if wrong, then they don't really know the answer. • It will encourage the students to have confidence in their knowledgeIt is more fair - a thoughtful and confident correct answer deserves more marks than a lucky hunch • Efficient study requires that students constantly question how their ideas arise, and how reliable they are • It encourages a reflective approach to learning Gardner-Medwin, 2006

20. Multiple true false A 28 year old woman with one child has taken anti-thyroid drugs for 6 months for thyrotoxicosis. She has a friend who has been successfully treated with radioiodine. She finds she frequently forgets to take her drugs and wants to stop them to have radio-iodine treatment. A. She should be told that because of her age radio-iodine is best avoided. B. The problems associated with radio-iodine should be discussed with her. C. Surgery as a possible alternative should be discussed with her. D. She should be advised that some form of further treatment is required. E. You should find out more about her friend’s treatment. Options are given as different combinations of the responses, The correct answer is: - true, B, C and D and false, A and E. Harden, R.M. & Dunn, W.G. (1981) Assessment a Work Manual, Dundee Centre of Medical Education in Brown et al 1997 from Loughborough University

21. Complex MCQ (Matching) Versus Matching MCQ An otherwise healthy 33-year-old man has mild weakness and occasional episodes of steady, severe abdominal pain, but no diarrhoea. One aunt and a cousin have had similar episodes. During an episode his abdomen is distended, and bowel sounds are decreased. Neurological examination shows a mild weakness in the upper arms. These finding suggest a defect in the biosynthetic pathway for: A. collagen B. corticosteroid C. fatty acid D. glucose E. haem* F. thyroxine (T4) Simple MCQ Acute intermittent porphyria is a result of a defect in the biosynthetic pathway for: A. collagen B. corticosteroid C. fatty acid D. glucose E. haem* F. thyroxine (T4)

22. Extended matching • More complex with multiple questions and answers on a common theme • Basis • A theme • Lead in statement • Multiple scenarios/questions • Options Example:

23. Extended Matching For each of the following patients with a myocardial infarction select the most likely complication from the list below. Each option may be used once, more than once or not at all. A 72 year old man is admitted to the Coronary Care Unit following a myocardial infarction. Seven days later he complains of severe trouble breathing and soon after, he collapses. On examination he is pale. His right leg appears swollen compared to the left. The apex beat is at the 5th intercostal space, mid-clavicular line. There are no murmurs audible but there are occasional bi-basal crackles in his chest. His pulse is 128/min, blood pressure 98/55 mmHg, temperature 37.7 C and jugular venous pressure is elevated. B) A 62 year old woman is admitted to the Coronary Care Unit following a myocardial infarction. Three days later she has become very unwell. On examination she is breathing noisily and her ankles are swollen. The apex beat is at the 6th intercostal space, anterior axillary line. There is a pansystolic murmur radiating to the axilla. Examination of the lungs reveals crackles at both bases and midzones. Her pulse is 126/min, blood pressure 105/65 mmHg, temperature 37.3 C, and respiratory rate 24/min. Her jugular venous pressure is raised etc.. Multiple questions and multiple answers

24. Asystole Atrial fibrillation Cardiac tamponnade Complete heart block Deep vein thrombosis Papilliary muscle rupture Pericarditis Post myocardial infarction syndrome Pulmonary embolism Pulmonary oedema Unstable angina Ventricular fibrillation Ventricular septal rupture Ventricular tachycardia (Medical Schools Council, 2012)

25. Assertion Reason (ARQs) • Assertion-reason questions are used to explore cause and effect and identify relationships between statements and hence test application/analysis. • When writing assertion-reason questions, keep in mind the following points: • The reason should be a free standing sentence so that it can be considered separately from the assertion. • Avoid using minor reasons. These can result in an ambiguous question. • Repeat options A-E in full for each question.

26. Example of assertion reason ATrue/True Reasonis correct explanation BTrue/TrueReason Is NOT a correct explanation CTrue/False DFalse/True EFalse/False Assertion High speed is a factor in car accidents Reason Most modern cars can reach speeds in excess of 100mph because…

27. Activity On each table is an example of a type of a more complex Multiple Response Question In your group devise a question area using principles from last task At the end pass your question to the next table for feedback using the checklist

28. Checklist for questions Does the question avoid: Repeating text in the question and the answer Double negatives Use of ‘all of the above’/ ‘none of the above’ Giving clues in the question (e.g. use of an/a etc) Consider cultural bias / incusivity Does the question: • Test the level that was intended • Have a clearly worded stem • Have only one clearly correct answer • Have a distractor that is similar in wording and length to the correct one • Have plausible distractors

29. Can also use MCQs to test higher levels Application/Analysis and Evaluation

30. MCQ for testing Analysis "The story is told of the famous German Organic Chemist AugusteKékulé who was struggling with the problem of how the six carbon atoms of benzene were linked together. He was getting nowhere with the problem, and one day fell asleep in front of the fireplace while he was pondering on it. He dreamt of molecules twisting and turning around like snakes. Suddenly, one of the snakes swallowed its own tail and rolled around like a hoop. Kékulé woke up with a start, and realized that his problem could be solved if the six carbon atoms of benzene were attached to each other to form a ring. Further work showed that this was entirely correct." The above passage illustrates a particular phase of the creative process. Which one is it? 1. preparation 2. incubation 3. orientation 4. illumination 5. verification

31. MCQ for testing Evaluation Question – define the creative process “The creative process is believed to take place in five stages, in the following order: ORIENTATION, when the problem must be identified and defined, PREPARATION, when all the possible information about the problem is collected, INCUBATION, when there is a period where no solution seems in sight and the person is often busy with other tasks, ILLUMINATION, when the person experiences a general idea of how to arrive at a solution to the problem, and finally VERIFICATION, when the person determines whether the solution is the right one for the problem." How would you judge this student' s answer? 1. EXCELLENT (all stages correct in the right order with clear and correct explanations) 2. GOOD (all stages correct in the right order, but the explanations are not as clear as they should be). 3. MEDIOCRE (one or two stages are missing OR the stages are in the wrong order, OR the explanations are not clear OR the explanations are irrelevant) 4. UNACCEPTABLE (more than two stages are missing AND the order is incorrect AND the explanations are not clear AND/OR they are irrelevant)

32. Checklist for tests Does the test overall: • Test the range of content? • Test: knowledge/comprehension/application/analysis/ evaluation/synthesis as intended? • Avoid giving away answers to questions in other questions? • Have a range of a/b/c/etc correct answers • Consider inclusivity

33. Pros and Cons of MCQs Disadvantages Time to compile questions Skill and scrutiny still required in the setting process Difficulties in compiling questions for higher order cognitive skills cannot assess innovation/creativity Concerns re guessing Partial knowledge not recognised in more straight forward questions If only used formatively may give students unreal expectations in other forms of assessment Concerns re relatively high marks Advantages • Banks of questions created and can be used for reuse/sharing • Reliable (if set correctly…) • Marking is time efficient, no second marking required • Rapid feedback to students and staff • Enables assessment of large range of curriculum

34. Conclusion

35. References Anderson, L . W., Krathwohl D. R., Airasian, P. W., Cruikshank, K.A., Mayer, R.E., Pintrich, P.R., James Raths, & Wittrock, M.C. (eds). (2000). A Taxonomy for Learning, Teaching, and Assessing: A Revision of Bloom's Taxonomy of Educational Objectives.Allyn and Bacon Bloom, B. S., Engelhart, M. D., Furst, E. J., Hill, W. H., & Krathwohl, D. R. (1956). Taxonomy of educational objectives: the classification of educational goals; Handbook I: Cognitive Domain New York, Longmans, Green, 1956 Brown, G., with Bull, J., and Pendlebury, M. (1997). Assessing Student Learning in Higher Education. London: Routledge. Chickering, A.W. & Gamson, Z.F. (1987). Seven Principles for good Practice in Undergraduate Education. American Association for Higher Education Bulletin, 39(7): 3-7. Accessed 2/6/12 Gardner-MedwinAR (2006)  Confidence-Based Marking – towards deeper learning and better exams  In : Innovative Assessment in Higher Education. Ed.: Bryan C and Clegg K.  Routledge, Taylor and Francis Group, London Fry, H., Ketteridge. S. and Marshall, S. (2005) A handbook for teaching and learning in higher education. Enhancing academic practice. 2nd edition. RoutledgeFalmer . Oxon. Hornby, Win (2003) Dogs, Stars, Rolls Royces and Old Double Decker Buses: Efficiency and effectiveness in assessment. Accessed on-line 24/6/12 http://www.enhancementthemes.ac.uk/docs/publications/reflections-on-assessment-volume-i.pdf Quinn F.M & Hughes S (2007) Quinn’s principles and practice in nurse education. 5th edition. Cengage learning. UK.

36. Bibliography Additional sources Constructing Written Test Questions For the Basic and Clinical Sciences (2002). 3rd Ed. National Board of Medical Examiners Designing effective objective test questions: an introductory workshop - Computer Assisted Assessment - Loughborough University Medical Schools Council (2012) http://www.medschools.ac.uk/MSC-AA/examplequestions/Pages/EMQs.aspx SEEC Credit Level Descriptors for Higher Education (2010) http://www.seec.org.uk/sites/seec.org.uk/files/SEEC%20Level%20Descriptors%202010_0.pdf UCL Home of Certainty-Based Marking http://www.ucl.ac.uk/lapt/ Writing multiple choice questions Virginia Commonwealth University Designing and Managing MCQs University of Cape Town

37. Examples

38. Q17. What is the scientific notation for 1,700,000? • 1.7 • 1.7 x 106 • 1.7 x 10-6 • 17 x 106 • 17 x 10-6

39. Q3: You invest £200 at a nominal interest rate of 7% per annum, compounded quarterly. What is the value of your investment after 3 years? • £200(1 + 0.07/4)12 = £246.29 • £200(1 + 0.07)3 = £245.01 • £200(1 + 0.07/3)12 = £263.78 • £200 + 1.073 = £201.23 • (£200 x 0.073) + £200 = £200.07 • £200(1 + 0.07)7 = £225.82 • None of the above 90 Countdown