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Writing Effective Multiple-Choice Questions (MCQ)


Last Updated:
January 23, 2024

First Published:
January 31, 2023


Multiple-choice questions inclusive of a question/stem, a key/correct answer, and distractors/incorrect answer choices are frequently used in health science education due to efficiency in grading and their frequent inclusion on licensing and board examinations. In addition to these advantages, Brame (2013) asserts that multiple-choice questions can be a reliable, valid, and versatile assessment form if they are constructed appropriately. Writing effective multiple-choice questions help you accurately assess your students’ knowledge, clinical judgement, and critical thinking skills.   

Use the comments section below to let us know your ideas about writing multiple-choice questions.

  1. Align all test questions with learning objectives/outcomes to ensure you are assessing what you are teaching. 
  2. When writing the question also known as the stem: Be clear; don’t teach or explain information in the stem; don’t include words in the stem that clue students to the correct answer; avoid negatively stated questions; avoid ending in a colon 
  3. When writing answer choices: all should be similar in length, detail, and complexity; avoid “all of the above” or “none of the above”; avoid using “always”, “never”, “sometimes”, and “occasionally”
  4. When writing the correct answer: ensure there is only one correct answer; randomly assign the correct answer among the choices