Multiple Choice Questions MCQs Ensuring the question fits

Multiple Choice Questions (MCQs) Ensuring the question fits the purpose 1

Your aims for the session • Please discuss where you are at with the use of MCQs and what you are aiming to achieve by the end of this session with the person next to you 2

When setting up this workshop our aims were to cover: • An overview of assessment principles • How to develop basic multiple choice questions • How to use MCQs in the assessment process Ø I. e. some theory and some hands on…. Ø And from your aims…. . 3

Use of MCQs at UH • Paper – In class tests – Written exams • Study. Net quizzes • EVS – Within sessions • Check understanding • Feedback for staff – Assessment • Formative • Summative – Homework function • QMP (Questionmark Perception) 4

Considerations when creating MCQs Pedagogical • • • 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 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 (Chickering and Gamson, 1987) 5

Considerations when creating MCQs Pedagogical 1) Learning outcomes Module Session – SEEC level descriptors 2) Considering the effectiveness and efficiency of practice and assessment from both students’ and staffs’ viewpoint 6

Considerations when creating MCQs Staff/Resource Efficiency (or 1/t) Effective vs. efficient assessment Waste of time Educational Effectiveness 7

Considerations when creating MCQs Bloom’s most quoted domain – the cognitive 8

Revised by Anderson in the 1990’s Nouns to verbs and the top two reversed 9

Considerations when creating MCQs SEEC level descriptors Southern England Consortium for Credit Accumulation and Transfer • Level 3 -8 – Setting – Knowledge and understanding – Cognitive skills – Performance and practice – Personal and enabling skills • Task for you…. On your tables you have the SEEC level descriptors for 4, 5+6 …. . without the level headings…. which is which…. ? ? 10

Thus far. . Module LOs Session LOs MCQ Bloom’s /Anders on SEEC level descript ors 11

Types of MCQs • Simple – True/False – One correct answer • Multiple Response Questions – – Multiple True/False Matching items Extended matching Assertion Reason – Marking gets more complex • E. g. Confidence marking/Negative marking 12

Some examples • To start you thinking • Locate your EVS clicker……. 13

The main stadium for the London Olympics in 2012 is located in: 1. 2. 3. 4. Great Britain British Isles England Scotland 14

Quintin Mc. Kellar who was previously VC at the Vet School joined the University in? 1. 2. 3. 4. December 2010 January 2011 February 2011 January 2020 15

MCQs 1. 2. 3. 4. Are reliable Are easy to mark Are easy to produce Can only be used to test the cognitive domain 16

Possible problems around those questions? 17

Components of an MCQ Well formed STEM Clearly correct answer Options Plausible distractors Good MCQ +/- feedback 18

Stems • 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 19

Options Correct answer and Distractors – Distractors should be worded in a similar way to the correct answer and of a similar length (but not too close to cause confusion) – Avoid repeating the same content in the options – move it to the stem if possible – Avoid ‘all of the above’/ ‘none of the above – Aim to use common misconceptions/student errors as distractors – Distractors should be plausible – There should be a sufficient number of distractors. • A correct statement but not the answer to the question is a good distractor 20

On each table – using the hand-out Can you write better stems and options for the previous 3 questions? The main stadium for the London Olympics in 2012 is located in? Quintin Mc. Kellar who was previously VC at the Vet School joined the University in? MCQs…. . 21

True/False Two possible alternatives so fair chance of getting the right answer… • Some tips: – As in multiple choice questions generally, use negatives sparingly. – 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. – 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 22

Any questions on basic MCQ writing at lower levels of Bloom/SEEC 23

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 24

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

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 knowledge It 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

Multiple true false Student’s clinical judgement is assessed: 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. Correct answer: - true, B, C and D: - false, A and E. Examples from Harden, R. M. & Dunn, W. G. (1981) Assessment a Work Manual Dundee Centre of Medical Education in Brown et al 1997 from Loughborough University 27

More complex MCQ – termed matching Simple MCQ Versus 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 (T 4) 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 (T 4) 28

Extended matching • More complex with multiple questions and answers on a common theme • Basis – A theme – Lead in statement – Multiple scenarios/questions – Options – An example - next 2 slides 29

Extended Matching Multiple questions and multiple answers 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) 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 5 th 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 mm. Hg, 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 6 th 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 mm. Hg, temperature 37. 3 C, and respiratory 30 rate 24/min. Her jugular venous pressure is raised etc. .

Options • • • • 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 From the Medical Schools Council, 2012 31

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: Ø The reason should be a free standing sentence so that it can be considered separately from the assertion. Ø Avoid using minor reasons. These can result in an ambiguous question. Ø Repeat options A-E in full for each question. 32

Example of assertion reason Assertion High speed is a factor in car accidents A B BECAUSE Reason Most modern cars can reach speeds in excess of 100 mph C D E True/True Reason is correct explanation True/True Reason Is NOT a correct explanation True/False/True False/False 33

Activity • For each table there is an example of a type of a more complex Multiple Response Question • In your group devise a question using principles from last task • At the end pass your question to the next table for feedback…. Asking for: – is the stem clearly worded ? – are the options clear and unambiguous? – what level of Bloom/Anderson does it address? 34

Feedback from Activity 35

Can also use ‘simple’ MCQs to test higher cognitive levels • Application/Analysis and Evaluation 36

MCQ for testing Analysis • "The story is told of the famous German Organic Chemist Auguste Kékulé 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 37

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) 38

Checklist for questions Do all the questions? Do the questions avoid? • Test the level that was intended • Have a clear stem • Have only one clearly correct answer • Have a distractor that is similar in wording and length to the correct one • Have plausible distractors • 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) • Cultural etc bias 39

Checklist for questions as a whole • Does the test overall: – Test the range of content? – Test the range of: • knowledge/comprehension/application/analysis/ evaluation/synthesis that was intended? – Avoid giving away answers to questions in other questions? – Have a range of a/b/c/etc correct answers – Consider inclusivity 40

Pros and Cons of MCQs generally Participant's thoughts ? 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 Disadvantages • • Time to compile questions Skill and scrutiny still required in the setting process Unable to test practical skills 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 41

From the workshop flyer the objectives were……. . By the end of the session the participants will: • Be conversant with the assessment principles • Be able to write basic level MCQs • Identify how MCQs may be used in the assessment process • Have we achieved these? if not plans to fulfil them…. 42

References and Bibliography 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 Educatio n. American Association for Higher Education Bulletin, 39(7): 3 -7. Accessed 2/6/12 Designing and Managing MCQs University of Cape Town Gardner-Medwin AR (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. 2 nd edition. Routledge Falmer. Oxon. HEA Legal Centre – how can I write effective MCQs? University of Leeds 43

References and Bibliography 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-assessmentvolume-i. pdf Quinn F. M & Hughes S (2007) Quinn’s principles and practice in nurse education. 5 th edition. Cengage learning. UK. A Guide to using Multiple Choice Questions and other Objective Test Questions La Trobe University Writing multiple choice questions Virginia Commonwealth University Constructing Written Test Questions For the Basic and Clinical Sciences (2002). 3 rd Ed. National Board of Medical Examiners Designing effective objective test questions: an introductory workshop - Computer Assisted Assessment - Loughborough University Writing MCQs for clickers is different (Pb wiki) - part of a whole section on writing MCQs SEEC Credit Level Descriptors for Higher Education (2010) http: //www. seec. org. uk/sites/seec. org. uk/files/SEEC%20 Level%20 Descriptors%202010_0. pdf Numerous medical books with examples of MCQs used for the medical Membership exams (MRCP) 44