Quick Guide:

Writing Learning Objectives and Exam Questions


Exam Question Writing

Detailed guide and examples:

NBME Test Question Writing Guide   Download

USMLE Step 1 Content Descriptions and Practice Questions   Download

USMLE Step 1 Laboratory Reference Values   Download

NBME Tutorial:

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:  www.nbme.org/IWTutorial.


Dr. Bosch's short list of tips:

  1. Write exam questions based on several of the more important, take-home messages of your teaching session, which are relevant to the students' future clinical education. The exam questions must be from the learning objectives.
  2. Try to test application of knowledge (problem-solving skills, integration and synthesis of information), rather than simple recall of isolated facts.
  3. If possible, place each question in the context of a short (2-3 sentence) clinical vignette.
  4. The emphasis should be on the pathophysiology of disease processes and basic principles of their diagnosis and management, rather than on more advanced clinical decision-making and treatment.
  5. Spell out abbreviations.
  6. If you are including clinical laboratory values in the question, also provide the reference ranges. A table of the USMLE Step 1 Laboratory Reference Values is posted here for your convenience.
  7. Use single-answer, multiple-choice questions with AT LEAST 5 answer options (A-E). Alternatively, you can write extended matching questions with multiple answer options from which the students must select (up to 26 choices, A-Z).
  8. All of the answer options should be:
    • brief
    • homogeneous (all diagnoses, all disease mechanisms, all morphologic features, etc.)
    • plausible, taught in the relevant course/unit (but not necessarily by you), and able to be ranked from "most correct" to "least correct";
    • approximately the same length
    • grammatically consistent with the stem
    • ordered alphabetically (or numerically)
  9. Avoid:
    • absolutes (always, never)
    • vague terms (usually, frequently, rarely)
    • answer options that say "all of the above", "none of the above" or other combinatorial statements
    • negative questions (with EXCEPT or NOT in the stem)
  10. A final check to see if your question is good is to cover all of the answers and be sure that you can still answer the question ("cover-the-options" rule).

Writing Learning Objectives

Sample Lead-In:

After studying the material presented in this lecture and in the related instructional resources, the student should be able to:

Sample Action Verbs for Learning Objectives (more available in the posted table):

Table of additional action verbs   Download