Writing an MCQ is a complex task that tests your understanding of the course materials and their interactions. While the format may be familiar, several factors must be considered when writing them.

Writing an MCQ

Each question should include the following:

Component	Description
Clinical vignette/case study	Realistic, patient-centric scenario with rich clinical detail. Include test results rather than stating ‘Test results were normal.’ Provide normal ranges for any included test results.
Multiple choice question	Should test understanding of the clinical scenario. Include 5 answer options: 1 correct and 4 incorrect. List answers alphabetically to avoid bias. Indicate the correct answer in bold with [x]. Ensure answer options are homogeneous (same type: all diagnoses, all tests, etc.). Avoid ‘all/none of the above’ and negative phrasing (‘which of the following is incorrect?’).
Explanation	Provide a short paragraph explaining why the correct answer is correct. The explanation is for tutors and reviewers, not students.
References for further reading	Provide a reference to support the correct answer. References are for tutor and reviewer use only.

Example of an MCQ:

A 56-year-old man is referred to the two-week rule lung cancer clinic with shortness of breath on exertion and a persistent cough. He has a 30-pack-year smoking history. Chest X-ray shows a left upper lobe collapse, and a staging CT scan reveals a cavitating lesion with an enlarged left hilar node. What is the next step?

1. Arrange for a CT-guided biopsy
2. Discuss with oncologists and refer for radical radiotherapy
3. Discuss at lung cancer MDT, arrange for a full lung function test and a PET scan with a view to surgical resection [x]
4. Give 6 weeks of antibiotics and repeat CT scan
5. Repeat CT scan in 3 months

Explanation:

This is a case of early-stage lung cancer in a current smoker. A PET scan and lung function test should be arranged, and the patient should be referred for surgical resection as surgery offers the best outcome.

Reference:

Lung Clinical Expert Group (2017). National Optimal Lung Cancer Pathway

How do we evaluate the questions?

These criteria, adapted from Swanson and Case (2002), will be used to assess MCQ quality:

1. Each item should focus on an important concept related to clinical practice.
2. Questions should assess application of knowledge, not recall of isolated facts.
3. The question stem must pose a clear question and allow an answer without viewing the options.
4. All answer options should be homogeneous and logically ordered.
5. Avoid technical flaws that give away the correct answer or add irrelevant difficulty.

Marking Rubric

Grade	Criteria
Distinction	Outstanding knowledge and critical ability.
Merit	Well-defined focus, good working knowledge, and competence in critical assessment.
Pass	Adequate working knowledge with some analysis.
Condonable Fail	Limited knowledge of core material and critical ability.
Fail	Lacking in basic knowledge and critical ability.