PUBH 6300 – Introduction to Public Health
Guide to Write Good MCQs
Prepared by Dr Tazeen Majeed & Prof Erica James, including other resources.
Guide to Writing Good Multiple Choice Questions (MCQs)
What is a good MCQ?
A well-constructed MCQ tests the application of knowledge (context-rich) rather than just
the recall of information (context- free). The focus of good MCQs should be on problems
that would be encountered in public health practice rather than an assessment of the
student’s knowledge of trivial facts or obscure problems that are seldom encountered.
MCQ Structure:
1. Focus on one important concept per MCQ e.g. Millennium Development Goals is the
chosen concept in the example given below.
2. Select an appropriate context for the chosen concept e.g. Gender Equality
Basic MCQ model:
The basic MCQ model comprises a stem and a lead-in question followed by a number of
answers (options).
Example:
STEM: The MDGs were the eight goals with measurable targets and clear deadlines for
improving the lives of the world's poorest people by 2015.
LEADING QUESTION: Which of the following was a target for the MDG goal to promote
gender equality and empower women?
OPTIONS: A. Eliminate gender disparity in the workplace by 2015
B. Eliminate gender disparity in primary and secondary education by 2015
C. Reduce by one half, by 2015, sex-selected abortions
D. Reduce by three quarters, between 1990 and 2015, the maternal
mortality ratio
PUBH 6300 – Introduction to Public Health
Guide to Write Good MCQs
Prepared by Dr Tazeen Majeed & Prof Erica James, including other resources.
Stem: Introduces the problem or concept to be tested.
• Stems should be designed so that students who know the material can find the
correct answer.
• In well-structured MCQs, the problem is introduced in the stem. Therefore, students
should be able to think of possible answers to stem and leading question, without
having to see the options.
• Stem could be short (such as example above) or it could be long depending on the
concept you are trying to test.
• You could also write vignettes / case scenarios.
Leading Question: Introduces the main question for MCQ and leads to the options.
• This question should be short, specific and clear.
• AVOID confusing leading questions such as “Which of these is NOT indicated? “ OR
“All of above are correct, except?” – These questions are poor assessors of actual
knowledge.
• If you wish to assess contradictions, then your leading question should clearly
indicate this.
Options / Answers: To answer the leading question, there can be four or five answer
choices—either is acceptable. If you can easily write five then use five, but sometimes the
fifth one is so silly it’s not worth including.
A good set of answer choices has the following characteristics:
• Short and readily understood. Options should be similar in length and amount of
detail.
• Congruent (i.e. all express similar concepts, such as four possible examples of health
inequities)
• Should NOT be half right/half wrong, or wrong because it includes something non-
existent.
• Avoid use of never, always, only, all, rarely, usually, commonly – these are
considered vague terms and can unnecessarily confuse students.
• It is important that your option’s list be HOMOGENOUS and one of the options
selected as the key answer to the question.
• DO NOT use the options ‘All of above’, ‘None of above’, ‘2 of above’.
PUBH 6300 – Introduction to Public Health
Guide to Write Good MCQs
Prepared by Dr Tazeen Majeed & Prof Erica James, including other resources.
Correct Answers and Distractors:
The option which matches the key in a MCQ is best called “the correct answer” and the
other options are the “distracters”.
• The aim is not to trick students with complex language, we want to test
understanding of concepts. Therefore, make sure there is ONLY ONE correct answer.
• Make the distractors appealing and plausible.
• A good distracter should be inferior to the correct answer but should also be
plausible to a non-competent candidate
• Do not use ‘All of above’ and ‘none of above’
• Hints for writing distractors:
i) Common misconceptions and common mistakes
ii) True statements that do not answer the leading question
iii) Use the same technical words or phrases in the distractor as you would in a
correct answer
iv) Language and length of distractors should mirror language and length of
correct answers
Some important tips:
• Once the MCQs have been written, they should be critically read and reviewed by
you, before final submission.
• Balance the difficulty level of your test questions. Try to address this use this
technique for your five questions:
i. Progressively more challenging questions allows for separation of students
(HD from D from C from P from F)
ii. Easy questions test a student’s knowledge
iii. Medium difficulty questions test comprehension
iv. Harder question test a student’s ability to apply concepts and do analysis
• For your ‘Correct Answer’ include a model answer explaining and justifying the
response.
• For each ‘Distractor’ include a justification – why that is incorrect.
PUBH 6300 – Introduction to Public Health
Guide to Write Good MCQs
Prepared by Dr Tazeen Majeed & Prof Erica James, including other resources.
Example – MCQ structure to avoid!
LEADING QUESTION: Which of the following can be best labelled as a social determinant of health
OPTIONS: A. Income & Social Status
B. Having diabetes
C. Access to health service
D. A & B only
E: B & D only
Example – Good MCQ structure
STEM: World Health Organization (WHO) defines ‘Social determinants of health (SDoH)’ as the
conditions and systems in which people are born, grow, work, live, and age which shape up their health
and life.
LEADING QUESTION: A huge range of factors can be considered Social Determinants of Health (SDoH).
What are the MAIN SDoH according to WHO?
OPTIONS: A. Early child development
B. Access to Private Health Insurance
C. Alcohol consumption
D. Exercise
CORRECT ANSWER: Early child development
EXPLANATION:
There are a number of approaches to define and describe SDoH. SDoH can include all the direct or
indirect factors affecting our physical, mental and social wellbeing. However, World Health
Organization has identified some main categories of SDoH. Early child development is one of them.
According to WHO “the physical, social/emotional, and language/cognitive domains of development,
each equally important—strongly influences well-being, obesity/stunting, mental health, heart disease,
competence in literacy and numeracy, criminality, and economic participation throughout life.” [1]
All the other options may impact health and wellbeing of individuals, however they are not the main
SDoH. The main SDoH a/c to WHO include: Employment conditions; Social exclusion; Gender equity;
Early child development; Globalization; Urbanisation; Health systems. [2]
Reference:
1. WHO. Social Determinants of Health. Accessed 9th March 2019. Available from:
[Link]
2. WHO. Social Determinants of Health. Accessed 9th March 2019. Available from:
[Link]
