Whilst some people disregard the Multiple Choice Question (MCQ) exam format as being ’too easy’, it is being increasingly used in all areas of education, from secondary to university and even professional education. This is at least partially because it allows marking to be automated, but there are a number of benefits the system offers students, and contrary to popular belief, well-constructed great MCQs can test high-level thinking and problem solving skills rather than simply being a test of fact recall. This guide is for educators and students wanting to know how to write good, challenging MCQs, which we believe is a great way to study and reinforce knowledge. At a Glance
- Anatomy of a Multiple Choice Question (MCQ)
- Tip 1: Just have ONE correct answer
- Tip 2: Present options in an alphabetical or numerical order
- Tip 3: Choose a specific piece of knowledge that you want to test
- Tip 4: Questions should be self contained
- Tip 5: Avoid ‘easy’ (non-functioning) distractors
- Tip 6: Distractors should be picked for good reasons
- Tip 7: Avoid committing to words such as ‘never’ or ‘always’
- Tip 8: Be consistent in choosing your distractors
- Tip 9: Phrase your questions as simply as possible
- Tip 10: Avoid negative questions
Anatomy of a Multiple Choice Question.
Let’s take the following example question: ‘John is a 68 year old man complaining of chest pain. Which of the following tests would be most appropriate to order first?”
- A) An electrocardiogram (ECG)
- B) A chest X-ray
- C) A DXA scan
- D) A cardiac stress test
This is a fairly standard multiple choice question we might expect to see on a multiple choice medical exam such as the USMLE, consisting of:
- A ‘Stem’ (the question or scenario)
- Distractors (the wrong options)
- A Key (the right answer)
The beginning part of an MCQ is referred to as the ‘stem’ because it isn’t always a ‘question’ in the strict sense of the word, and students could be asked to fill in a missing word or, as with the question above a brief scenario or case study may be presented alongside the question.Now that you know what the terms are, let’s jump in to our top tips for writing good questions! These are based on years of experience writing tests and evidence from professional educators which we’ve referenced at the end. So in no particular order…
Tip 1: Just have ONE correct answer
A number of formats encourage users to ‘select ALL options that apply’, and do not disclose to students how many correct answers there are. This is a fairly lazy way to construct multiple choice questions, and it doesn’t allow you to isolate functional units of understanding to test them.
Tip 2: Present options in an alphabetical or numerical order
If you don’t follow this rule, then you’re opening your test results up to be biased towards certain positions.
Tip 3: Choose a specific piece of knowledge that you want to test
One advantage of traditional testing methods is that you can ask quite broad questions. Consider for example writing a test for chemistry students. One large area you would want to test is students’ knowledge of how the periodic table was developed. So you could simply have a question that said:“Write 2-3 paragraphs on the history of how the periodic table was developed” (15 marks)On your mark scheme, you would know what you were looking for and could give, say 2 marks if the student correctly identified Dimitri Mendeleev as the inventor of the ‘modern’ periodic table, 1 mark if they pointed out that this was the first time atoms were arranged in order of atomic number etc. With MCQs, you are testing much smaller and more focused pieces of knowledge with each question. Furthermore, there can be no ambiguity or room for argument in the question. For example, a very simple MCQ that tests a student’s knowledge of the periodic table would be:Who developed the periodic table?
- A) Mendeleev
- B) Lavoisier
- C) Newlands
- D) Hinrichs
To anyone studying chemistry, Mendeleev is the obvious ‘key’ here as he is most commonly credited with developing the modern periodic table, but each of the other ‘distractors’ all played their own crucial roles, and the question “Who developed the periodic table?” is not as clear-cut as it first seems, there are many scientists and historians out there who would put forward arguments that Newlands was deserves credit as the ‘real’ inventor of the table. This creates multiple problems: Firstly, you are punishing ‘more-able’ students who have done extra background reading and understand the question’s ambiguous nature, and rewarding students who have simply remembered that ‘a Russian-sounding guy made the periodic table’. This is a key point and one you should bear in mind when creating any MCQ: You are asking questions in a completely closed format, so make sure there is no ambiguity and that knowledge is being rewarded appropriately. You’ve probably already realised, therefore, that a better stem would be:“Who is most commonly credited with having developed the modern periodic table?”
Tip 4) Questions should be self-contained
- A) Fish
- B) Mammals
- C) Amphibians
- D) Reptiles
- A) They are cold-blooded
- B) They are closely related to whales
- C) They belong to the same class of animal as elephants
- D) There are considered to be highly intelligent animals
Tip 5) Avoid ‘Easy’ (non-functioning) Distractors
Unless you happen to very confidently know the correct answer, how hard this question is largely depends on how hard it is to eliminate the distractors. People writing tests often draw the distinction between ‘functioning’ versus ‘non-functioning‘ distractors. A so-called ‘non-functioning‘ distractor is basically a filler option: officially defined as a distractor which is selected by less than 5% of students, they are answers that are obviously wrong, as shown in the ‘easy’ example below:– A) Thomas Edison
- B) Fred Flintstone
- C) Selma Hayek
- D) Steve Jobs Even if you have never heard of Thomas Edison, it is very easy to know the correct answer here simply by eliminating the ridiculous, non-functioning ‘distractors’.
- A) Thomas Edison
- B) James Watt
- C) Benjamin Franklin
- D) Alexander Bell
Suddenly, the same question is made much harder as none of the names here are immediately out of place: each person here made some contribution to the field of ‘early electricity’.
Lesson 6) Distractors should be picked for good reasons
We’ve already established that you should aim to create functioning, rather than non-functioning distractors in your questions: this simple rule will be enough to stop your questions being bad, but it won’t necessarily make them good! To really effectively answer the question “Does this student know and understand this point?”, your distractors should address specific misconceptions about a particular question, for example:What is the most commonly fractured bone in the human body?– A) The clavicle
- B) The hip
- C) The ankle
- D) The scaphoidThis is a good question as it is unambiguous, and consists only of functioning distractors.
There is only one correct answer here (the clavicle, or ‘collar bone’), but each of the other options are also commonly fractured, and the fact that each of them are liable to fracture in specific circumstances is a key fact students will learn about them. Hip fractures, as you will know are a very common and serious disability occurring mainly in elderly women. In fact, in this sub-group they are probably the most fractured bone by far, which may throw off some students who don’t have all their facts straight.If we changed the distractors, for example to other bones such as ‘Tibia’ (in your shin) or ‘Cranium’ (skull), whilst they are probably still ‘functioning’ distractors, they are a lot easier to rule out as unlike the distractors in the first question, these are not addressing any particular pitfall or misconception that a lot of students may falsely believe, and therefore the question is not going to differentiate ‘more able’ from ‘less able’ students in the same way.
Lesson 7) Avoid committing to words such as ‘never’ or ‘always’
Which of the following is NOT a side-effect of aspirin?
- A) Dry cough
- B) Tinnitus
- C) Stomach ulcers
- D) Spontaneous bruising
Medical students will know what the ‘correct’ answer here is straight away, for non-medics: Tinnitus, stomach ulcers and spontaneous bruising are very well-known and fairly specific side effects for aspirin, if someone on aspirin came to you presenting with one of them then aspirin would probably be your first suspect. A cough, on the other hand is not really associated with aspirin (although other common drugs can cause a dry cough). Dry Cough isn’t a bad distractor by any means, as dry cough is the main side effect of another well-known class of drugs often taken in conjunction with aspirin, so it’s perfectly valid to test whether the student can accurately differentiate between the two. So what’s the problem? ‘is NOT’ is a very categorical statement. If that student happens to have done a lot of extra research on the side effects of aspirin, its perfectly possible that he knows of an obscure article somewhere with evidence that aspirin can cause a dry cough. In reality, the student at this level should know the ‘correct’ answer despite this by deciding which is the ‘least incorrect’ answer, but still why not absolve yourself of blame and angry, pedantic emails after the exam by rephrasing it to:
Tip 8) Be consistent in choosing your distractors
If you’re going to use ‘All of the above’ or ‘None of the above’ answers, make sure you use them consistently throughout the test and not just on a handful of questions: if you only use it in a few questions then it’s a dead-giveaway for students that it’s the right answer, and even if you’re actually using it as a distractor it can mislead students who would otherwise have picked a different answer they were reasonably confident in.Similarly, bear in mind that if ‘All of the above’ is present as an option, then identifying one distractor is enough to eliminate it as an option, and similarly identifying correct answers is enough to identify it as the key. (a)Another pitfall that you’ve probably seen yourself is inconsistent distractors within a single question. Consider the following question:When considering treatment options, doctors should take into account all of the following EXCEPT:
- A) The physical, mental and social wellbeing of their patients
- B) The safety and effectiveness of the pharmaceutical, surgical or other treatments they prescribe
- C) The personal, cultural and religious beliefs of their patients
- D) The patient’s condition only
Tip 9) Phrase your questions as simply as possible
- Avoid using double-negatives where possible
- Be wary of adding in extraneous, irrelevant details to ‘throw off’ students (red-herrings)
- Unless specifically testing a student’s technical vocabulary, don’t use complex words where simpler ones will do
Tip 10) Avoid negative questions
Anyone can write an MCQ, but writing a good one that accurately tests a piece of knowledge and the student’s ability to apply it takes a bit more thought. Take time to ask yourself what it is you want to test with a particular question, and construct a question designed to do that. We welcome you to try out Synap, our artificial intelligence tool for creating MCQ tests, practising them and sharing them with other people.We have over 200,000 questions written by our users and professional content writers on a huge range of topics. Sign up today and quiz your friends for free with synap, whether you are interested in learning about wrist anatomy, the kashmir earthquake orfrench er verbs , we have something for everyone!
Here are some more guides to writing great MCQs, we used them when we were starting Synap and refer back to them regularly!
- Writing good Multiple Choice Test Questions, Brame CJ.
- 14 rules for writing multiple-choice questions, Brigham Young University.
- How to write a good multiple choice question