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Multiple Choice Questions (MCQs) are one of the most important well established tools used for assessment and selection processes in medical education. Designing good assessment tools requires time and effort and ultimately determines the learning outcome. The quality of MCQ depends on the quality of items on the whole and presence of efficient distractors. Flawed MCQs interfere with assessment process and therefore it is vital to develop reliable and valid items that are free of such flaws. Basic criteria for constructing good quality MCQs include item content that is tested and well-structured, flawless items. Three areas that are addressed in this article include general guidelines of using MCQ inevaluation, principles of constructing effective MCQs, and constructing higher order MCQs. Characteristics of effective MCQs are determined by the overall item, the stem and distractors. Interpretation and problem-solving items like MCQs with data, diagrams and images, use of clinical or lab vignettes, formats like Extended Matching items, Key feature questions and assertion reason questions require higher order thinking skills like analysis, synthesis and evaluation. Significant commitment and technical knowhow is required to prepare MCQs that are of good quality, reliable, able to test higher order thinking skills and consistent with curriculum objectives. Constructing MCQs is an art which can be perfected with practice and it is essential for medical educators to be skilled in effective test item writing to assess the learner's knowledge.
Kar et al. (Thu,) studied this question.