General guidelines given to Physician question writers. 

·         Most guidelines ask board exam question writers to avoid including ambiguous information as it may mislead examinees from residency and fellowship programs. However, it is inevitable that you will find some ambiguous content in your questions.

·         Question writers are also asked to avoid ambiguous terms in the question’s lead line. These include “commonly, rarely, usually, frequently” etc which can be misinterpreted by USMLE or Internal medicine board exam takers.

·         The purpose of each question is to test one “teaching principle”. The teaching principle becomes the “testing objective” of the question.

·         The lead line of a question should be very specific about the information asked and should represent the testing objective of the question.

·         Good medical board question: A good question is constructed in such a way that a well-read physician from a residency or fellowship program is able to pick the correct answer from the choices given.

·         Bad board question: A bad question is constructed in such a way that a well-read physician from a residency or fellowship program wrongly answers the question because of confusing choices.

·         All “choices” must represent genuine medical information. For example, a choice should not be a “made up” syndrome name.

·         Questions should be straightforward and not tricky. The object of the exam is not to trick examinees. It is to test each physician’s medical knowledge and clinical problem solving ability.

·         Each question must test only one teaching principle. Testing more than one teaching principle should be avoided in a single question. For examples on teaching principles and testing objectives, refer to MKSAP multiple-choice questions and accompanying explanations. 

·         Board questions and testing objectives should represent diseases seen in daily medical practice. Common conditions like Diabetes, chest pain, MI, COPD, vaginal infections, Hypertension, Obesity etc., will be given importance and may be the majority of the exam content.

·         Rare diseases are not usually tested, except if that disease can be potentially life threatening.

·         Board question writers have been asked to avoid negative questions. For example, “All of the following choices are correct EXCEPT”.

·         When presenting the choices, only one must be the correct answer. Controversial choices must be avoided. A well-read physician from a residency or fellowship program should be able to pick the correct answer.

·         The incorrect choices presented are called “distracters”.  Distracters are usually partially correct, but not fully correct.

·         Avoid using “all of the above” and “none of the above”, as answer choices.