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Reliability is defined as the degree to which a test consistently measures a learning outcome. The reliability is enhanced when the number of MC items focused on a single learning objective is increased. In addition, the objective scoring associated with multiple choice test items frees them from problems with scorer inconsistency that can plague scoring of essay questions.

Validity is the degree to which a test measures the learning outcomes it purports to measure. Because students can typically answer a multiple choice item much more quickly than an essay question, tests based on multiple choice items can typically focus on a relatively broad representation of course material, thus increasing the validity of the assessment.

The key to taking advantage of these strengths, however, is construction of good multiple choice items. A multiple choice item consists of a problem, known as the stem, and a list of suggested solutions, known as alternatives. The alternatives consist of one correct or best alternative, which is the answer, and incorrect or inferior alternatives, known as distractors. The stem should be meaningful by itself and should present a definite problem.

A stem that presents a definite problem allows a focus on the learning outcome. The stem should not contain irrelevant material , which can decrease the reliability and the validity of the test scores Haldyna and Downing The stem should be negatively stated only when significant learning outcomes require it.

Students often have difficulty understanding items with negative phrasing Rodriguez If a significant learning outcome requires negative phrasing, such as identification of dangerous laboratory or clinical practices, the negative element should be emphasized with italics or capitalization. The stem should be a question or a partial sentence. A question stem is preferable because it allows the student to focus on answering the question rather than holding the partial sentence in working memory and sequentially completing it with each alternative Statman The cognitive load is increased when the stem is constructed with an initial or interior blank, so this construction should be avoided.

All alternatives should be plausible. The function of the incorrect alternatives is to serve as distractors,which should be selected by students who did not achieve the learning outcome but ignored by students who did achieve the learning outcome.

Common student errors provide the best source of distractors. Alternatives should be stated clearly and concisely. Alternatives should be mutually exclusive. Alternatives should be homogenous in content. Alternatives that are heterogeneous in content can provide cues to student about the correct answer. Alternatives should be free from clues about which response is correct. Sophisticated test-takers are alert to inadvertent clues to the correct answer, such differences in grammar, length, formatting, and language choice in the alternatives.

In either case, students can use partial knowledge to arrive at a correct answer.

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