Construction of Single Best Answer (SBA) in MBBS Curriculum.pptx

Construction of Single Best Answer (SBA) in MBBS Curriculum

The Single Best Answer (SBA) format is an essential component of modern medical education, particularly in the MBBS curriculum. This presentation explores the principles and best practices for constructing high-quality SBA questions that accurately assess medical students' knowledge and clinical reasoning skills. Topics include the format of an effective SBA question, common pitfalls to avoid, and strategies for aligning SBAs with learning objectives and competency-based outcomes. Additionally, we will discuss the role of SBAs in assessments and provide practical tips for educators to create fair, reliable, and valid questions. By mastering the art of SBA construction, educators can enhance the quality of assessments and ultimately improve medical education outcomes.

1. CONSTRUCTION OF SINGLE BEST ANSWER (SBA) IN MBBS CURRICULUM 24TH FEBRUARY Dr Naila Awal Associate Professor Department of Pathology

2. Understand SBA Format Define the structure and key components of SBA questions. Enhance Question Quality Learn principles for writing clear and effective SBA questions Develop Clinical Reasoning Ensure SBAs assess critical thinking and decision-making Avoid Common Pitfalls Identify and correct errors in SBA question construction Objectives

3. What is a Single Best Answer (SBA)? SBA is a type of multiple-choice question where learners choose the single best option from a list of plausible answers. 🔹 Example: A histopathological study is performed to analyze characteristics of malignant neoplasm in colonoscopic biopsy specimens. Which of the following microscopic findings most likely indicates malignancy? A Pleomorphism B Atypia C Invasion ✅ D Increased nuclear/cytoplasmic ratio E Necrosis

4. Multiple Choice Question versus Single Best Answer Aspect Multiple Choice Questions (MCQ) Single Best Answer (SBA) Question Answer Choices May have multiple correct answers Only one best answer, others plausible Assessment Focus Tests factual recall and measures isolated knowledge Assess clinical reasoning & Evaluates decision-making skills Question Structure Options are Independent choices are related, requiring careful selection Guessing Factor Higher chance of guessing correct answers Reduces guessing the likelihood of correctly

5. MCQ Which of the following is a common feature of apoptosis? Inflammation Cell shrinkage ✅ Necrotic debris Maintain membrane integrity✅ Formation of cellular bleb✅ 💡 Focuses on factual recall, allowing multiple correct answers, with independent answer choices that do not require clinical reasoning Examples of MCQ Versus SBA

6. SBA question A liver biopsy from a patient with chronic hepatitis B reveals hepatocytes undergoing cell death without inflammation. The cells appear shrunken with nuclear fragmentation. What is the most likely mechanism of cell death? Apoptosis ✅ Necrosis Fatty degeneration Caseous necrosis Liquefactive necrosis 💡 Requires clinical reasoning rather than simple recall. While all options describe different pathological processes, apoptosis is the best answer due to the key histological features. Examples of MCQ Versus SBA

7. 03 02 01 Stem (Vignette) (Background clinical information/a scenario/a sentence/ figure) Format of Single Best Answer (SBA) Lead-In Statement/ Question (A single line that asks a specific question) Options (Possible answer:4 to 5 Best :1 Distractors:3-4)

8. Format of Single Best Answer (SBA) A 16-year-old girl develops wheezing and dyspnea after exposure to dust and pet dander. Which of the following mediators plays a key role in this hypersensitivity reaction? A) Histamine and leukotrienes ✅ B) Interferon-gamma (IFN- γ) C) Nitric oxide D) Transforming growth factor-beta (TGF- β) E) Tumor necrosis factor-alpha (TNF- α) Stem Question Options

9. Guideline for making Single Best Answer (SBA) Blueprint Components of SBA Blueprint: Topic Areas: Identifies the subject areas to be covered (e.g., Anatomy, Pathology, Pharmacology,). Learning Objectives: Question content should align with the curriculum and the course learning objectives. Cognitive Levels: Categorizes questions according to Bloom's Taxonomy, such as recall, understanding, application, analysis, synthesis, and evaluation.

10. Guideline for making Single Best Answer (SBA) Blooms Taxonomy (revised) For learning

11. Guideline for making Single Best Answer (SBA) A 55-year-old male with chronic gastroesophageal reflux disease (GERD) undergoes an endoscopy, which reveals intestinal metaplasia of the esophageal mucosa. What is the most likely underlying cellular adaptation ? Dysplasia Hyperplasia Hypertrophy Metaplasia ✅ (Correct Answer) Neoplasia Lower order thinking skills(LOTS) Lower order thinking skills (LOTS) question (Level :Understanding)

12. Guideline for making Single Best Answer (SBA) Higher order thinking skills (HOTS) question (Level :Analyze) A 65-year-old male with a history of smoking and chronic obstructive pulmonary disease (COPD) presents with hemoptysis and weight loss. Imaging reveals a mass in the upper lobe of his right lung. A histopathological examination confirms small cell lung carcinoma . Which of the following paraneoplastic syndromes is mostly associated with small cell lung carcinoma? Hypercalcemia Cushing syndrome Syndrome of inappropriate antidiuretic hormone (SIADH) ✅ Lambert-Eaton syndrome Hypertrophic osteoarthropathy Higher order thinking skills (HOTS)

13. Typical SBA layout Blue print code and level (integration/interpretation, problem solving/clinical scenario) Stem and image if relevant Lead in A clear and focused question based on the clinical case. Options (all on a continuum, all plausible to some extent) Option 1 Option 2 Option 3 Option 4 Option 5 Justification for correct answer Explanation of why the correct answer is the best choice. Discussion of why the other options are incorrect

14. Typical SBA layout Blue print code and level (interpretation/clinical scenario) Stem and image if relevant A 65-year-old man presents with progressive fatigue, unintentional weight loss, and intermittent blood in stool for the past three months. On examination, he has mild pallor but no palpable abdominal masses. Colonoscopy reveals a large ulcerated mass in the sigmoid colon, and a colonoscopic biopsy followed by histopathology confirms adenocarcinoma. Lead in Which tumor marker is most useful for monitoring this patient's disease progression? Options (all on a continuum, all plausible to some extent) CA 19-9 CEA AFP PSA hCG

15. Typical SBA layout Justification for correct answer b) Carcinoembryonic Antigen (CEA) is the most useful tumor marker for monitoring colorectal carcinoma progression and response to treatment. Why Other Options Are Incorrect: CA 19-9 is mainly used for pancreatic adenocarcinoma. AFP is used for hepatocellular carcinoma and germ cell tumors. PSA is specific for prostate cancer. hCG is used for trophoblastic disease and testicular tumors.

16. Guideline for making Single Best Answer (SBA) Stem Focus on common and important topics Question Length: Each question should take no longer than 45 seconds to read and answer, as student typically have 60-90 seconds per question. Stem Length: Limit each stem to 5-10 lines, including investigation results; even shorter if accompanied by a table or picture. Impact of Long Questions: Long questions lowering reliability and limiting the scope of knowledge assessed.

17. Guideline for making Single Best Answer (SBA) Stem Structured Presentation of Clinical Information: Information should be presented in the sequence of a clinical assessment. Age, sex, and presenting complaint should come first, followed by past, family history, with examination and investigations structured in a set order. Original A 26-year-old man undergoes major thigh surgery after a motorcycle crash. Three days later, he collapses. Rewrite A 26-year-old man collapses suddenly on the ward. Three days ago, he had major thigh surgery after a motorcycle crash.

18. Guideline for making Single Best Answer (SBA) Stem Follow a consistent style guide: : use either hyphenated or unhyphenated age descriptors (e.g., an 86-year-old man), refer to sex as 'man' or 'woman,’(not ‘gentleman’ or ‘lady’), and maintain consistent spelling (e.g., 'fetus' or 'foetus’). Writing questions in the present tense feels more relevant

19. Guideline for making Single Best Answer (SBA) Stem Raw data over formulation: Use actual clinical data instead of interpretations to improve question discrimination. Example: ❌ Instead of: “She is pyrexic and tachycardic.” ✅ “Her temperature is 38.5°C and pulse rate is 121 bpm” Using data better reflects clinical practice and requires candidates to draw their own conclusions from the clinical information.

20. Guideline for making Single Best Answer (SBA) Things to avoid in Stem ❌irrelevant background information. ❌ inclusion of the reader in the question Example : You are a junior doctor working in emergency department when a 37-year-old patient presents with…”) “✅– (e.g. “A 37-year-old male presents to the emergency department with…”). ❌Pathognomonic terms Example: Instead of: “Rebound tenderness is present” (for peritonitis assessment) ✅ “Sudden removal of the palpating hand results in pain”

21. Guideline for making Single Best Answer (SBA) Things to avoid in Stem ❌ Should not contain clue Example: A 70-year-old male smoker presents with hemoptysis and weight loss. A lung biopsy reveals poorly differentiated squamous cells with high nuclear-to-cytoplasmic ratio. Which lung cancer type is most likely? A) Adenocarcinoma B) Small cell carcinoma C) Squamous cell carcinoma✅ D) Large cell carcinoma E) Carcinoid tumor

22. Guideline for making Single Best Answer (SBA) Lead-In Statement/Question: Use complete sentence E.g ✅Which is the likeliest anatomical site of the lesion in this patient? ❌The likeliest anatomical site of the lesion is- Ask for the BEST answer, ❌TRUE/FALSE. ✅Examples: "What is the most likely diagnosis?“ "Which investigation should be performed first?“ "Which investigation is most useful for a definitive diagnosis?“ "What is the most appropriate initial management?“

23. Guideline for making Single Best Answer (SBA) Things to avoid in Lead-In Statement/Question: Negative words like "not" or "except" in lead-ins, as they can be confusing. If necessary, capitalize them (e.g., NOT, EXCEPT). No negative questions: “least likely’ diagnosis”

24. Guideline for making Single Best Answer (SBA) Options : Structure of Answer Options Key Answer: The single best response (about 80% correct). Distractors: Partially correct (20–30% correct). A 45-year-old man with chronic alcohol use presents with jaundice, ascites, and hepatomegaly. The histopathological report of liver biopsy shows bridging fibrosis and regenerative nodules. What is the most likely diagnosis? A) Acute viral hepatitis B) Liver cirrhosis ✅ (Key Answer – 80% correct) C) Alcoholic hepatitis D) Non-alcoholic fatty liver disease E) Hepatocellular carcinoma

25. Guideline for making Single Best Answer (SBA) Options : Characteristics of Distractors Similar in length – Avoid making the correct answer significantly longer. ❌ Incorrect (Original One): Question: What is the characteristic feature of reversible cell injury? Nuclear pyknosis Mitochondrial damage Cellular swelling, which occurs due to failure of the Na+/K+ ATPase pump leading to intracellular accumulation of water. Karyorrhexis Apoptic body

26. Guideline for making Single Best Answer (SBA) Options : Characteristics of Distractors Similar in length – Avoid making the correct answer significantly longer. ✅ Corrected (Worked One): Question: What is the characteristic feature of reversible cell injury? Nuclear pyknosis Mitochondrial damage Cellular swelling Karyorrhexis Apoptic body

27. Guideline for making Single Best Answer (SBA) Options : Consistency and Homogeneity: The correct answer and distractors should be from the same category (e.g., investigations, treatments, prognosis). ❌ Incorrect (Original One): Which of the following is a complication of diabetes mellitus? A. Retinopathy (complication – correct answer) B. Insulin (treatment) C. Polyuria (symptom) D. HbA1c (diagnostic test) E. Hypertension (risk factor)

28. Guideline for making Single Best Answer (SBA) Options : Logical Arrangement of Options Arrange options numerically or alphabetically when applicable. Example : Alphabetical Order A 40-year-old man presents with a stab wound to the left lower abdomen. The surgeon needs to explore the injury by sequentially incising the layers of the abdominal wall. Which of the following is the first layer encountered after the skin? External oblique ✅ (Correct) Internal oblique Peritoneum Rectus abdominis D) Transversus abdominis

29. Guideline for making Single Best Answer (SBA) Options : Logical Arrangement of Options Example : Numerical Order A 25-year-old male is brought to the emergency department after a motorbike accident. On examination, he opens his eyes only to painful stimuli, produces incomprehensible sounds, and localizes to pain. What is his Glasgow Coma Scale (GCS) score? 3 7 10 ✅ (Correct) 13 15

30. Guideline for making Single Best Answer (SBA) Options : Ensure the Best Answer Is an Option Writers sometimes exclude the best answer, instead focusing on the second-best option. 🔹Original question : A 15-year-old boy develops myoclonic jerks and has a generalized tonic- clonic seizure. The doctor discusses the best long term antiepileptic treatment What treatment is most likely recommended? A. Ethosuximide B. Lamotrigine C. Levetiracetam✅ D. Phenytoin E. Topiramate

31. Guideline for making Single Best Answer (SBA) Options : Ensure the Best Answer Is an Option 🔹Rework: A 15-year-old boy develops myoclonic jerks and has a generalized tonic- clonic seizure. He has previously tried sodium valproate, but this caused troublesome weight gain; he wishes to try a different treatment. The doctor discusses the best long-term antiepileptic treatment. What treatment is most likely recommended? A. Ethosuximide B. Lamotrigine C. Levetiracetam✅ D. Phenytoin E. Topiramate

32. Guideline for making Single Best Answer (SBA) Options : Things to avoid Do not use absolute terms like “always,” “never,” “all of the above,” or “none of the above.”

33. and Tips for Integrating Clinical Scenarios into Basic Science Questions 6 hours?’ Another example, ‘The doctor explains that the Basic science questions can often be made clinically relevant Anatomy : Link conditions to clinical cases. For example, ‘A 19-year-old man develops a dropped foot after fracturing his fibula. What nerve is most likely affected?’ Histology : Clinically relevant questions can be created by presenting a biopsy of normal tissue from a patient with any organ disorder and asking, for example, ‘What cell type most likely predominates?’

34. and Tips for Integrating Clinical Scenarios into Basic Science Questions 6 hours?’ Another example, ‘The doctor explains that the Biochemistry and physiology questions can be more challenging since patients rarely visit doctors for issues related to normal function. Physiology : Questions may involve normal responses to investigations. Example: A 45-year-old man undergoes a treadmill test for breathlessness, with normal results. What is his most likely maximum heart rate? Biochemistry : A biochemistry investigation may relate to normal fluid balance or normal effects of starvation in an otherwise healthy patient undergoing surgery.

35. Quality Control Peer Review: Questions reviewed by colleagues or experts for accuracy and clarity. Reviewing the Item: Is it clinically relevant? Answerable without options? Readable in one minute? Plausible options with one best answer? Free from common pitfalls? Explanation and References: Prepare explanations for each question.

36. Importance of using SBAs in Medical Education ✅Enhances Clinical Decision-Making : Encourages students to apply knowledge in real-world scenarios Example : A 45-year-old man presents with chest pain radiating to his left arm. The ECG shows ST-segment elevation in leads II, III, and aVF . What is the next best step in management? Administer beta-blockers Administer nitroglycerin Administer oral aspirin Administer thrombolytic therapy Perform coronary angiography

37. Importance of using SBAs in Medical Education ✅Encourages Deep Learning : A 28-year-old woman at 38 weeks of pregnancy presents with severe abdominal pain, nausea, and vomiting. She is diagnosed with acute appendicitis. What is the most appropriate management for this condition in pregnancy? Laparoscopic appendectomy B) Open appendectomy ✅ (Correct) C) Antibiotics alone D) Expectant management E) Peritoneal dialysis

38. Importance of using SBAs in Medical Education ✅Encourages Application-Based Learning Focuses on practical application of knowledge. ✅Improves Assessment Reliability : Minimizes guesswork with a single best response, ensuring fair evaluation. ✅Aligns with Global Exams : Familiarizes students with international testing standards ( e.g.,USMLE , PLAB, AMC).

39. SBA Mark Distribution in MBBS Curriculum 4 th Phase MCQ : 40 marks Medicine Paper 1 SBA: 10 + MTF: 10 Paper 2: SBA: 10 + MTF: 10 Surgery Obstetrics & Gynecology 1 st Phase MCQ : 40 marks Anatomy Paper 1 : SBA: 10 + MTF: 10 Paper 2: SBA: 10 + MTF: 10 Physiology Biochemistry 2 nd Phase MCQ : 20 marks Pharmacology and Therapeutics SBA: 10 + MTF: 10 Forensic Medicine and Toxicology 3 rd Phase MCQ : 20 marks Community medicine and Public Health SBA: 10 + MTF: 10 Pathology Microbiology

40. Conclusion Well-structured SBA questions are essential to assess higher-order thinking skills but are challenging to create. A systematic approach aligned with learning objectives is essential. Faculty development is crucial for improving question quality and assessment strategies. Institutions can arrange in training programs focused on SBA question construction and test blueprint implementation. Enhancing assessment quality ensures better evaluation of students’ critical thinking and problem-solving abilities.

41. If you don't know where you are going, you may end up somewhere where you didn't intend to..

42. References Creating High Quality Single Best Answer Questions: A Guide for Medical Educators. https://www.researchgate.net/publication/383421167_Creating_High_Quality_Single_Best_Answer_Questions_A_Guide_for_Medical_Educators Single best answer question-writing tips for clinicians https://eduimed.usm.my/EIMJ20221402/EIMJ20221402_09.pdf A Guide for Writing Single Best Answer Questions to Assess Higher-Order Thinking Skills Based on Learning Outcomes https://eduimed.usm.my/EIMJ20221402/EIMJ20221402_09.pdf IEHMS Guide to Question Writing for the Healthcare Programmes Tips For Clinicians On Writing Single Best Answer Questions https://www.bmj.com/careers/article/tips-for-clinicians-on-writing-single-best-answer-questions How to Write Single Best Answer (SBA) Questions https://geekymedics.com/geeky-medics-guide-writing-single-best-answer-sba-questions/#:~:text=A%20single%20best%20answer%20question%20has%20a%20clinical%20scenario%20(the,the%20scenario%20and%20posed%20question . SBA writing guidelines Writing better SBA https://medicaleducators.org/write/MediaManager/Speakers/Phil_Smith_-_Writing_better_SBAs.pdf Construction of Multiple Choice Question (MCQ)-ppt by Prof. Dr Tahmina Begum https://slideplayer.com/slide/14346581/#google_vignette