Exams: Board-Style Exam Items

Writing Board Style Items: What is a board-style exam item? How do I write one? Item writing starts with reflecting on your objectives. If your objectives are aimed at basic recall or application of previously learned content, a general format exam item like the one on the left may be a good fit. However, if your objectives are aimed at multi-step, higher order thought processes like synthesis or clinical reasoning, a board style item may be a better fit. The item on the right is written in board style, meaning it follows a specific format of presenting information within a clinical scenario. Board style items help students apply knowledge in context, prepare for the style of items they’ll experience on medical licensure exams, and begin thinking like a clinician in terms of clinical reasoning. For these reasons, we recommend introducing students to board style items early on in exams and increasing the percentage that they see across time. A board style item stem combines a clinical scenario with a lead in. The clinical scenario provides pertinent details about the patient and the context and the lead in is the call to action. It represents the actual question or prompt. Your lead in should focus on a single objective and require the students to read the clinical scenario to be able to respond. Your answer options are a combination of the key, or correct response, alongside the distractors, or incorrect responses. Distractors are also referred to as foils. They should be close to correct options that a good handful of students will probably pick. So, a board style item is made up by a clinical item stem plus multiple choice answer options. Here’s an easy template for writing board style items that is included in our job aid for board style exam item writing linked at the end of this video. All you have to do is fill in the highlighted areas and select answer options. As previously noted, you want to identify your objective when you start writing an item. Your objective should align with the exam blueprint, be appropriate for your learners’ educational level, and focus on universally taught concepts or information that are likely for general practice physicians to encounter or that have serious impacts when they are not considered. Additionally, we recommend writing a rationale for your item. This will help both you and the students. Thinking about your rationale and using related references can help you write more plausible distractors. Also, if students have questions about the item, having the rationale and the reference available makes it easy for you or others to respond with valid information that supports their learning. Because MSUCOM is a DO program, we encourage you to represent osteopathic practice in board style items when it makes sense. You can consider item objectives that relate to the osteopathic tenets of body unity, self-regulation, or structure and function. For instance, maybe your item focuses on identifying postural imbalance in a patient with chronic pain or recognizing anxiety in a patient diagnosed with scleroderma. You can also integrate somatic dysfunctions, such as those related to visceral reflexes or Chapman’s points, into the item if it can be done in a chronologically smooth and relevant way. You could also consider including osteopathic manipulative medicine or treatment techniques in the stem or answer options, such as core strengthening or application of anterior pressure to the sacral apex. Additionally, the National Board of Medical Examiners, or NBOME, has released extensive guidance on person-centered and bias-free language in item stems. This provides guidance on addressing a wide range of topics including but not limited to age, body weight, disability, ethnicity, gender, pregnancy, relationships, spirituality, and so on. Don’t hesitate to contact the Instructional Design and Assessment team for more information on exam tagging, item statistics, and other assessment or instructional design topics. And don’t forget to visit bit.ly/msucomexams to check out our job aids on exams and other topics.