Writing Test Questions

Constructing Written Test Questions for the Basic and Clinical Sciences

A manual was written by the NBME to help faculty members improve the quality of the multiple-choice questions written for their examinations.  The manual provides an overview of item formats, concentrating on the traditional one-best-answer and matching formats. It reviews issues related to technical item flaws and issues related to item content. The manual also provides basic information to help faculty review statistical indices of item quality after test administration. An overview of standard-setting techniques is also provided. Issues related to exam blueprinting are not addressed in any detail. The focus is almost exclusively on the item level, leaving exam level planning for another manuscript.

**According to Tulane's exam policy, all internal exam questions MUST adhere to the NBME guidelines for writing test questions.  You may access the manual by CLICKING HERE.

NBME Tutorial

The NBME is pleased to announce a complimentary online item-writing tutorial:  Writing Multiple Choice Questions:  An Introductory Tutorial.  This self-paced, interactive tutorial provides a foundation for writing quality multiple-choice questions.  The tutorial introduces some of the main principles of item writing to individuals who write questions for examinations in the field of medicine or across the health professions.

  • Featured topics include:
  • the anatomy of an item
  • basic rules for writing good stems and options
  • characteristics of a quality "best-answer" item
  • writing items to assess clinical reasoning
  • common item flaws
  • strategies for evaluating test items

The tutorial is organized into sections so that you can complete only a portion of it and easily return later; the entire tutorial takes about 45 minutes to complete.  You can access the tutorial on the NBME website at:

1430 Tulane Ave, New Orleans, LA 70112 504-988-5251