title: Quality assurance of item writing: during the introduction of multiple choice questions in medicine for high stakes examinations.
abstract: BACKGROUND
  One Norwegian medical school introduced A-type MCQs (best one of five) to replace more traditional assessment formats (e.g. essays) in an undergraduate medical curriculum. Quality assurance criteria were introduced to measure the success of the intervention.
  
  
  METHODS
  Data collection from the first four year-end examinations included item analysis, frequency of item writing flaws (IWF) and proportion of items testing at a higher cognitive level (K2). All examinations were reviewed before after delivery and no items were removed.
  
  
  RESULTS
  Overall pass rates were similar to previous cohorts examined with traditional assessment formats. Across 389 items, the proportion of items with >or=5% of candidates marking two or more functioning distracters was >or=47.5%. Removal of items with high p-values (>or=85%), this item distracter proportion became >75%. With each successive year in the curriculum the proportion of K2 items used rose steadily to almost 50%. 31/389 (7%) items had IWFs. 65% items had a discriminatory power, >or=0.15.
  
  
  CONCLUSIONS
  Five item quality criteria are recommended: (1) adherence to an in-house style, (2) item proportion testing at K2 level, (3) functioning distracter proportion, (4) overall discrimination ratio and (5) IWF frequency.
authors.affiliation: Faculty of Medicine, Health Sciences Centre, Kuwait University, Safat, Kuwait. jamesw@hsc.edu.kw
authors.forename: James
authors.initials: J
authors.lastname: Ware
authors.forename: Torstein
authors.initials: T
authors.lastname: Vik
mesh_terms: D002755:Choice Behavior; D004501:Education, Medical; D004521:Educational Measurement / Q000379:methods* / Q000592:standards; D005069:Evaluation Studies as Topic; D006801:Humans; D009664:Norway; D011786:Quality Control; D014956:Writing