1. Use the stem to include a short story (short problem, scenario-based)
and end the problem with a very clear question (e.g. which of the
following is ...). Eliminate excessive wordiness and irrelevant or unnecessary
information.
2. Use direct question not incomplete statements for the stem, e.g.
epilepsy is....
3. Include as much necessary information as possible in the stem so
that alternatives in the options can be kept brief.
4. Include in the stem words that would otherwise be repeated in each
option.
5. In testing for definitions, include the term in the stem rather than as
one of the alternatives.
6. List alternatives in separate lines rather than including them as part
of the stem so that they can be clearly distinguished.
7. Keep all alternatives in a similar format (e.g. all are phrases, all are
sentences, etc).
8. Make sure that all options are plausible to the stem (not just to
complete the list of 4 options).
9. Make sure that the options are homogenous ( i.e. all are enzymes, all
are hormones, all are drugs, all are diagnoses, all are next step
management , all are mechanisms, all are ions, ...etc)
10. Avoid un-necessary, tricky and complex options that need time for
reading and understanding.
11. Check that all choices are grammatically consistent with the stem.
12. Try to make alternatives of the same length.
13. No options with: none of the above, all of the above, or except.
14. Avoid using relative terms (like always, usually) versus an absolute
terms like never.
15. In the options, be careful when using numbers (arrange them
ascending or descending order) don't mix percentages with absolute
figures in the same item.
16. Don't use hints in the stem to point out to the correct option.
17. Don't give more information and more details in the correct option (
all options are the same) .
2
18. Use the Capital Letters ( A,B,C,D,E) rather than the lower-case
letter ( a,b,c,d,e) in the options.
19. Don't use negatively stated items.
20. Make sure that each item contains only one-best response to the
stem.
21. Four options are suitable in any item of a SBA.
22. Arrange the options alphabetically.
23. Use simple correct language and avoid complex difficult and strange
terms.
24. Apply the cover test to your item: if you hide the stem by your hand
the student can reach to the correct answer without even reviewing
the options.
25. The optimum number of words per item (WPI) in item vignette with
detailed data should not exceed 100 WPI, while in simple vignette (
less complex data) should not exceed 70 WPI.
26. The number of words in question line and options together should
not exceed 35-40 WPI.