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There are several simple principles you can use to write more effective items in terms of content, formatting the Question Stem and the Answer Options, and more.




  • Design items to reflect specific content/skills
  • Assess items that are relevant to the field
  • Use appropriate vocabulary for the target audience
  • Use material in novel ways
  • Include a published reference
  • Write items to the target audience
  • Classify each item according to the Domain and Task area
  • Develop ambiguous items
  • Overlap item content
  • Use opinion-based/subjective items
  • Use trick items
  • Use insensitive content
  • Write overly general content
  • Use approved item format
  • Use Answer Options of similar length
  • Verify the number of Answer Options
  • Use vertical formatting
  • Write Answer Options of varying length
  • Display Options out of proper sequence (e.g., numerical order)
  • Write Question Stems of similar length
  • Carefully proofread items
  • Verify item readability for the audience
  • Use "Absolute" language (i.e., Always or Never)
  • Write more information in the item than necessary
  • Teach the candidate information by including unnecessary facts
  • Provide clear directions
  • Pose a definite problem
  • Format the Stem as a question
  • Ensure that the Stem contains substance separate from the Options
  • Make the focus explicit
  • Evaluate all cognitive levels of thinking
  • Bold and use all caps when using "Emphasizers" (e.g., MOST, BEST, LEAST, etc.)
  • Create a Stem that is free of irrelevant material
  • Write negatively phrased questions (i.e., Which is NOT...)
  • Write open-ended questions (end with a colon)
  • Use excessive verbiage

Answer Options

  • Present a single correct Answer Option when only one is required to be marked as correct
  • Develop four Answer Options
  • Use reasonable or plausible distractors
  • Use typical errors as distractors
  • Be specific about frequency
  • Have another Subject Matter Expert (SME) review your items
  • Write Answer Options that are grammatically consistent with the Stem
  • Use the same 'form of speech' when writing Options (i.e., all begin with a verb)
  • Place Answer Options in logical or numerical order
  • Keep Options independent of one another (content should not overlap)
  • Keep the length of Options relatively equal
  • Use "All"/"None of the above"
  • Include more than one correct Answer Options when only one is required to be marked as correct
  • Use negative phrases
  • Overlap Answer Options
  • Use humor
  • Prompt the candidate to the correct Answer Option
  • Use "Absolute" language (i.e., Always or Never)
  • Write Answer Options of greatly varying length
  • Place Answer Options out of numerical or other logical order

You may be working on several projects when using ExamDeveloper as an author. You are assigned a certain number of items for each project. You can view your work assignments on the Project Writing Summary page.

What spellcheck options do I have for medical terms?


There are free medical dictionaries that can be uploaded into ExamDeveloper, such as:



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1 Comment

  1. [Sarahd, Google]

    Wow! This is very helpful. Love it.