Multiple choose question Item Writing.pptx

Multiple choose question Item Writing.

1. Welcome to Test Item Writing Training for Item writers and Reviewer 

2. Course Syllabus: Test Item Writing Training course Description  This Test Item Writing training is designed to equip item writers with all the necessary knowledge and skills required to carry out effective item development activities. The course emphasizes mainly the principles and guidelines of  effective item writing to enables you effectively write  well-structured items  to assess the application of basic and clinical  science knowledge This  training module is organized in the following  4 session  Session 1 : Introduction to assessment Session 2 : Written  cognitive knowledge test (MCQ)  and how to construct \ Session3 : MCQ flaws  and how to avoid them  Session4 : Writing well-structured MCQ using patient  vignette to assess the application of knowledge  Objective of the training  After engaging in this training, you will be able to:  Recognize basic principles of assessment-related item writing  Recognize the structure of MCQ items and their  principles for constructing each component   Identify flaws that question writers inadvertently  introduce into test questions Write a well-structured MCQ for basic and clinical sciences to assess the  application of knowledge. Pre-requisites  This Item writing training course require a successful   completion of   basic Effective Teaching skill(ETS)  or Higher Diploma Program Teaching-learning methods  and resources  It is Self-paced e-learning.  E‑contents which is complemented by some supplemental resources are offered to you.  You are free to learn at your own pace based on your needs and interests. Supplemental resources for further reading and understanding is offered to you at the end of each session.    Learning assessment methods  Formative assessment: During each session, you will be given practice questions and exercises to assess your learning progress and check your achievement of objectives. Summative evaluation: The quality of the work you've submitted will be assessed using a set of criteria. As a result, as part of the summative assessment, you must complete and submit all of the assigned activities at the end of the course. N.B. In order to receive successful certification and earn the assigned ———— CEU for the module/course, you must complete all tasks according to the course requirements.

3. Test Item Writing Session 1: Introduction to Assessment  This session will help you grasp the fundamental concept of assessment by focusing on assessment principles and threats to effective assessment. This session  will last approximately 20 to 25 minutes. You must read and analyze all of the important content provided in the form of text and graphics, as well as practice the exercises.

4. Test Item Writing Session Objectives At the end of this session,  you will be able to:  Recognize basic principles of assessment  related with item writing Recognize threats of assessment and thier remedies 

5. Test Item Writing Introductory activity Before moving to thier concepts , please write the difference that you think between ASSESSMENT , MEASURMENT , EVALUATION and TEST in the box provided  ( feel free to write what ever you think) You can compare your response with few points given by clicking  the feedback buttom .

6. 1.1. Assessment : Concept Assessment     Is systematic  process  of  collecting   and  evaluating   information/evidence (direct or indirect) from tests and other sources and  making judgments  about the progress of learning, achievement of objectives, achievement of competency after learning program, etc... Keywords : Collecting evidence,  evaluating evidence  and  making a judgment  What is evidence?

7. 1.1. Assessment : Concept… Evidence is information gathered in  assessment process which provides proof of competence Proof that supports the candidate’s claim of competency. Direct evidence Direct evidence is evidence that can be  observed or witnessed by the teacher/ assosser  .  This may include: Direct observation of    Performance of a task, or range of tasks, either in the workplace or in a simulated work environment, witnessed directly by an assessor Direct observation of a student's performance during oral examination/questioning  Direct observation student's performance while taking test exam  In direct evidence Indirect evidence is evidence of the trainee’s work that can be  reviewed or examined by the teacher(not directly observed while the students are doing but reviewed)   .  This may include: Review of reports, procedures, assignments  etc. completed  by the student (example : log book, portofoio ...) Review of  photographs, videos, etc. showing performance of a task when the assessor cannot be present Review  of technical qualities of finished product made by the trainees Review of project accomplished Supplementary evidences Third party reports:  Documented and verified reports from supervisor, colleague, subject expert, trainer or others

8. Test Item Writing Assessment Assessment is used as a broad category that includes all of the  various methods used to determine the extent to which the students are achieving the intended learning outcomes of instructions. This includes both testing ( knowledge test ) and  performance assessment . The  knowledge test tells how well the student knows what to do  and  performance assessment tells how skillfully the student can do

9. 1.2. Effective assessment  Write what effective assessment requires? Effective assessment requires: A clear  conception of intended learning outcome A variety of assessment methods that are relevant to the instructions Adequate sample of task Procedure that are fairness to everyone Performance criteria (what the students are achieving and how well?), Timely and detailed feedback to the student  Grading and reporting system that is in harmony with the assessment program

10. 1.3. Purposes of assessment Different assessments have different purposes and benefits. Some of the benefits/purposes of an assessment include: To better prepare graduates for their carrier To Ensure safe and effective practice To Help students  focus on critical components of the training To Encourage students  to improve their skills To Tailor  students to their future jobs To Create a sense of healthy competition among institutions  interns of preparing students before an exam Select what other  purpose of an assessment ( Multiple responses can apply) Which of the following that you think is the purpose of assessment ? To assess progress of learning To check achievement of objectives To determining competency after learning program To provides implicit feedback on where the student stands To improve of teaching methods / instruction , curricula and quality of learning To Identify placement, Advancement, Certify achievements etc …

11. Purpose of National Licensing Examination What do you think about  the purpose of asssement of National Licensing Examination? Which could be the main purpose of NLE ( Multiple response can apply) The purpose of the National Licensing assessment is ? To assess progress of learning To check achievement of learning objectives To determining competency after learning program To provides implicit feedback on where the student stands To improvement of teaching methods / instruction , curricula and quality of learning

12. 1.4. Principle of Assessment :Validity  Among the several principles of assessment , validity  and  reliability  are  key principles of assessment particularly related with item development  1.  Validity  It is the appropriateness, meaningfulness, and usefulness of specific  inferences made from test scores To what extent inferences   we made from test scores is appropriate, meaningful, and useful? So, How do we know our  test item is valid?  What are the evidence to infer  our test score is appropriate, meaningful, and useful ? Write  some of evidence of validity related to items development   Some of the EVIDENCE OF VALIDITY related to items  Large number of questions Question contents are aligned to the objective Question contents comprise a good sample of the discipline’s objectives Questions are not too difficult or too easy Questions are well written and clear

13. Threats of Validity  Any factors that interfere with the meaningful interpretation of assessment data are a threat to validity ! Can guess what factor that will affect test validity? ( threats of test Validity)  Too few questions /cases Inadequate sample Ambiguous question Inappropriate difficulty Too easy  Poorly crafted items/cases (incomplete statement, flaws, hetrogeneous options etc... Ill trained examiners  Trivial questions

14. Validity Threats  vs. Remedies

15. Test Reliability  Test Reliability is:  How consistent or reproducible are assessment results, scores, over time or occasions? How consistent and dependable our ratings of performance are? To what extent will the result be free from errors?...... Key reliability Questions Are you rating the same things similarly each time? similar to someone else rating the same behaviors? Remember! Assessment is unreliable if a candidate is likely to get a significantly different result If different examiners were used, or If the assessment were to be conducted at a different time, or in a different context using the same assessment task  RELIABILITY: NECESSARY, BUT NOT SUFFICIENT, FOR VALID INFERENCES

16. Reliability    Threats  vs. Remedies

17. Session Summary  Summary Test Validity is the appropriateness, meaningfulness, and usefulness of specific  inferences made from test scores Any factors that interfere with the meaningful interpretation of assessment data are a threat to validity Test reliability is How consistent or reproducible are assessment results, scores, over time or occasions RELIABILITY: NECESSARY, BUT NOT SUFFICIENT, FOR VALID INFERENCES Remember  Poorly crafted test items are one of the main threats of test validity Next up, we will see how to craft  a well written cognitive test item ( MCQ) to ensure test validity

18. Session 2: Written  cognitive knowledge test Session objectives  At the end of this session. you will be able to:  Describe desirable characteristics of written cognitive knowledge test Recognize the structure of MCQ Recognize principles of constructing   well-structured  MCQ item  

19. Written  Cognitive knowledge test(MCQ) structure and how to construct Cognitive knowledge test  includes both testing (knowledge test) and performance assessment. The knowledge test tells how well the student knows what to do and the performance assessment tells how skillfully the student can do.

20. Assessment of cognitive knowledge Assessment of cognitive knowledge encompasses all testing intended to measure examinee mental learning (i.e.) Acquisition of new information Integration of  new information with prior knowledge Change and/or modified Initial mental model Assessment of cognitive knowledge The most common and, arguably, the most important types of evaluation are used in medical education. Best assessed using  written test formats . Assessment of cognitive domain has to go high order learning which is an assessment of the application of knowledge, synthesis, and problem-solving ability. Properly constructed written assessment can address all levels of the cognitive domain.

21. 2.2. Desirable characterstics of written cognitive knowlodge test

22. Practice exercise: desirable characteristics   Match the desired characteristics of written cognitive knowledge test with their correct meanings The correct keyed response is indeed correct – objectivity Ensuring  the legitimacy and accuracy of the test scores and their inferences -defensibility Ensuring the test comprises adequate representation of  in each domain and large enough -valid evidence   A second administration of the same examination to the same examinees (assuming that they have learned or forgotten nothing) should produce about the same test scores -reproducibility

23. Practice exercise: desirable characteristics   Match the desired characteristics of written cognitive knowledge test with their correct meanings Able to defend the keyed correct answer  , its test scores and its pass-fail decisions to the students and in court . defensibility Ensuring questions are not too difficult or too easy and  are well written and clear -valid evidence   Little or no subjectivity or judgment involved in deciding whether a particular examinee's answer or response is right or wrong – objectivity Rating the same things similarly each time or similar to someone else rating the same behaviors- reproducibility

24. 2.3. Written cognitive assessments formats Selected -response Items  are test items that require examinees  to select  Constructed-response items  require examines to create response 

25. 2.4. Strengths and limitation of selected-response item formats

26. 2.5. Structure of MCQ and Tips for constructing well-structured MCQ item  The three components of MCQ  1. Stem 2. Lead-in 3. Options sets

27. Tips : MCQ  at a whole

28. Practice exercise Critically review  the following sample MCQ and decide whether the question as a whole fulfill basic rules of MCQ A 65-year-old man has difficulty rising from a seated position and straightening his trunk, but he has no difficulty flexing his leg. Which of the following muscles is most likely to have been injured? Gluteus maximum Gluteus  minimus Hamstrings Iliopsoa Obturator internus Is the question as a whole  Relevant for health workers clinical work and practice? Adress important content ?  Test application of knowledge ? Align with the aims and objectives of the health professional training?  program? Is trivial content or simple recall? Write your response in the space provided 

29. Evaluate the following sample stem using the above criteria Tips : Constructing STEM

30. Tips : Constructing Lead-in and Option

31. Sample well-structured Single Best Answer(SBA) A 47-year-old man is brought to the  emergency department 2 hours after the sudden onset of shortness of breath, severe chest pain, and sweating. He has no history of similar symptoms. He has hypertension treated with hydrochlorothiazide. He has smoked one pack of cigarettes daily for 30 years. His pulse is 110/min, respirations are 24/min, and blood pressure is 110/50 mm Hg. A grade 3/6, diastolic blowing murmur is heard over the left sternal border and radiates to the right sternal border. Femoral pulses are decreased bilaterally. An ECG shows left ventricular hypertrophy. Which of the following is the most likely diagnosis? Acute myocardial infarction Aortic dissection Oesophageal rupture Mitral valve prolapse Pulmonary embolism

32. Session 3: MCQ FLAWS AND HOW TO AVOID THEM This section will teach you how to identify and prevent common faults. These are problems that question writers mistakenly put into their test questions since they are focused on the topic and don't consider test-wise trainees who may benefit from these cues and are able to correctly answer questions despite knowing very little about the material.

33. Session objectives  At the end of this sessions, you will be able to:  Recognize the two major types of technical question flaws Identify flaws that question writers inadvertently introduce into  test questions

34. 3.1.Technical question flaws: What is it? You want your trainees to demonstrate their content knowledge rather than their test-taking ability!  Flaws provide an advantage to less knowledgeable trainees who are familiar with test-taking strategies. We recommend that you familiarize yourself with these flaws so that your questions are well-structured and do not contain flaws

35. 3.2. The two major types of technical question flaws 3.2. The two major types of technical

36. 3.3. Flaws related to test wiseness

37. 3.3.1. Grammatical cues An asymptomatic 57-year-old man comes to the physician for a routine health maintenance examination. He has smoked one pack of cigarettes daily for 37 years. His blood pressure is 180/112 mm Hg, and pulse is 82/min. Abdominal examination shows a bruit in the right upper quadrant and no masses. His hematocrit is 42%, serum urea nitrogen concentration is 23 mg/dL, and serum concentration is 1.4 mg/dL. The most likely cause of this patient’s bruit is an: accumulation of lipids in the arterial wall hypertrophy of the arterial wall media giant cell infiltration in the arterial wall round cell infiltration in the arterial wall Where is the error in the design of this question? In this sample question, only the correct answer (A) grammatically follows from the lead-in This type of flaw is easily avoided by using “closed lead-ins” so they are written as complete sentences in question format

38. 3.3.2.Logical cues Logical cues occur when a subset of the options is collectively exhaustive indicating that one of these options must be the answer. Example Crime is equally distributed among the social classes overrepresented among the poor overrepresented among the middle class and rich primarily an indication of psychosexual maladjustment reaching a plateau of tolerability for the nation Where is the error in the design of this question? Here, options A, B, and C are mutually exclusive and exhaustive, covering all possibilities, so one of these is probably the answer. In the example  above, D and E should be omitted since they are not logical to include, and the test-wise trainee will simply rule them out You really don’t need to have five options! Use the number of options that is right for the stem.

39. 3.3.3. Absolute terms Absolute terms such as "always" or "never" should be avoided. Test-wise trainees understand that options stated in absolutes are unlikely to be the correct answer. Example Which of the following statements about the memory defect associated with advanced dementia, Alzheimer’s type, is true? It can be treated adequately with phophatidylcholine (lecithin) It could be a sequela of early parkinsonism It is never seen in patients with neurofibrillary tangles at autopsy It is never severe It possibly involves the cholinergic system Where is the error in the design of this question? Here, trainees will gain an advantage by eliminating C and D as possible answers. In addition, inclusion of the word “adequately” in option A makes that option nearly absolute as well – there must be at least a few patients for whom lecithin is inadequate

40. 3.3.4. Long options By long options we mean options that actually have more words in them than other options! Almost always, long options are the correct answer. Example  An otherwise healthy 28-year-old woman presented with a two-day history of cough, fever and shortness of breath, and the following chest radiograph. What is the most likely diagnosis? A. Tuberculosis B. Community-acquired streptococcal pneumonia C. Varicella pneumonia Where is the error in the design of this question? When authors write their questions they tend to make the correct answer longer, more specific, or more complete than other options, and test-wise trainees know that long options are typically the correct answer. When you write your questions, be sure to check that the option length and specificity is similar so there is no cueing.  

41. 3.3.5. Clang association This is a very common flaw introduced by question authors who know the content and don’t think about repetition of words as they write their options. Test-wise trainees who do not know the answer are cued when a word or phrase used in the stem is repeated in the correct answer Example A 67-year-old woman is brought to the emergency department because of severe chest pain four hours after undergoing outpatient endoscopy and dilatation of an oesophageal stricture caused by reflux. At discharge, she reported no chest pain. Three hours later, she vomited a small amount of blood and had severe pain. She appears pale. Her temperature is 38°C (100.4°F), blood pressure is 140/85 mm Hg, pulse is 125/min, and respirations are 22/min. Examination shows crepitus in the neck and moderate epigastric tenderness. The lungs are clear to auscultation, and breath sounds are equal bilaterally. Rectal examination shows no masses; test of the stool for occult blood is positive. Which of the following is the most likely cause of these symptoms? A) Oesophageal perforation B) Mallory-Weiss syndrome C) Myocardial infarction D) Perforated gastric ulcer Where is the error in the design of this question? Can you see the clang? Here, the word ‘ oesophageal ’ is used in the stem and the options. In addition, the use of “perforated” in  option D provides another clue that this is part of the correct answer. Adding this up, A looks like the right answer! And that flaw is a “clang” association

42. 3.3.6. Convergence strategy Convergence strategy occurs when the correct answer includes the most elements in common with the other options Example Testing of which of the following nerves will provide the most useful information to establish the diagnosis? A) Median motor, peroneal motor, facial, and sural B) Median motor, peroneal motor, tibial H reflex, and facial C) Median motor, ulnar motor, facial, and sural D) Peroneal motor, tibial motor, peroneal F wave, and facial Where is the error in the design of this question? Can you see the convergence? Here, the repetition of phrases in the options clearly suggests that A is the correct answer because it includes the most commonly appearing terms in the other options. So, if we look more closely, the terms appear like this

43. 3.4. Flaws related to Irrelevant difficulty Flaws that add irrelevant difficulty. Added difficulty in a question, which adds nothing and is irrelevant to the content being tested

44. 3.4.1.  Overlapping of options Example Following a second episode of salpingitis, what is the likelihood that a woman is infertile? A)Less than 20% B)20% to 30% C) Greater than 50% D) 90% Where is the error in the design of this question? can you see overlapping options? There is an overlapping of options. Also notice that on this question, option C includes option D, which in all probability rules out D as the correct answer. Mixing formats makes questions unnecessarily confusing and adds irrelevancy  

45. 3.4.2. Use of Vague terms   Example  Which of the following statements concerning rhabdomyosarcosis is true? A) It  typically  arises in the striated muscle B) It is the  most  common malignant pelvic tumour in children C) Orbital tumours are  frequently  invasive D) Lymph node involvement  usually  occurs in tumours of the extremities E) Metastasis to the liver  rarely  occurs. Where is the error in the design of this question? Can you see the use of vague terms? The vague terms included (typically, common, frequently, usually, rarely) make this poorly structured question even more problematic. Although the question is technically an SBA, it is structured as a TF question and does not satisfy the cover-the-options rule; the options are heterogeneous. The question author and the trainees responding to this question are unlikely to have the same interpretation of the vague terms used in the options, adding irrelevant difficulty. There is some research evidence to support this assertion. These findings illustrate that there is no shared definition for these vague terms. So, they should never be used in MCQ questions      

46. 3.4.3. Use of "non of the above" Example  A 39-year-old man is brought to the Emergency Department by his brother because he has become increasingly forgetful and confused over the past 24 hours. The brother relays that the patient has been drinking heavily and eating very little for the past month and has become tremulous and slightly nauseous. He wanders at night because he cannot sleep. On admission, intravenous administration of 5% dextrose in water is initiated. Two hours later, the patient has ophthalmoplaegia and is completely confused. Which of the following is the most appropriate next step in patient care? A. Administration of an anticoagulant B. Administration of diazepam C. Administration of large doses of vitamin B1, intravenously D. Administration of large doses of vitamin C, intravenously E. None of the above. Where is the error in the design of this question? Can you see the problem? Use of “None of the above” as an option adds irrelevant difficulty. If trainees choose this option as the answer, it isnot clear whether they don’t know the answer or were thinking of a better answer than the options provided on the list. For this question, we would suggest changing the lead-in to: “Which of the following is the most appropriate next step in  pharmacotherapy ” and modifying option E to: “ No pharmacotherapy  is indicated at this time.

47. 3.5. Additional practice excercises#1  Identify the  FLAWS(no need to be content experts) Question #1 The purpose of the carm bar is to reinforce the: A. Carm B. Dentile C. Holtz D. Menton Which flaw you think the question illustrates? This is an example of the clang association.” The word, “ carm ” is given in the stem and repeated in the correct answer

48. excercises#2  Question #2  Identify the  FLAWS(no need to be content experts) Who co-authored the series of mystery books featuring Richard Masters as the lead investigator? A. Cronbach & Ebel B. Cronbach & Linn C. Cronbach & Meehl D. Meehl & Byron Which flaw you think  the question illustrates ? Convergence flaw. “Cronbach” is used three times and “ Meehl ” two times. The option with both Cronbach and Meehl is the correct answer.

49. excercises#3 Question # 3 Identify the  FLAWS(no need to be content experts) The menton is structurally reinforced by a: A. Amthalen B. Immont C. Octone D. Swanz Which flaw you think  the question illustrates? The flaw in this example is grammatical: only the correct answer ( Swanz ) grammatically follows from the lead-in. It is easy to avoid this flaw by simply using only complete sentences that end in a question mark. F or example, “Which of the following reinforces the menton ?” Consistent use of closed lead-ins will also help with satisfying the “cover-the-option” rule and with writing homogeneous options

50. excercises#4 Identify the FLAWS(no need to be content experts) The zirbser exhaust system occasionally backfires because: A. Its operating temperature is sometimes low B. No fuel ever reaches the exhaust pipe C. The pressure on it is always extreme D. The strain on it is never reduced Which flaw you think the question illustrates? The use of vague and absolute terms is cluing the correct answer in this question. Trainees know to avoid absolutes and will quickly pick-up that A is the correct answer because it includes the vague term, “sometimes.”

51. 3.6. Your checklist for question writing

52. Session 4:  Writing well-structured MCQ using Patient Vignettes to assess application of Basic and Clinical Science Knowledge This session gives emphasis  on  the important  guidelines for writing effective MCQs for the basic and clinical  sciences to assess application of  knowlede of learners. In addition the session provides various templates that  you can use  to structure  your MCQs for a variety of different purposes

53. Session Objectives At the end of this session, you will be able to:  To describe  basic guidelines  for writing  MCQs for the basic  and clinical sciences Write  well-structured   MCQs for  basic  and clinical sciences to assess the application of knowledge using templates  

54. 4.1.Purpose of Basic and Clinical  science exam  Basic and clinical science exams should: •  Be congruent with and reinforce major curricular goals and objectives •  Influence what faculty teach and what students learn •  Promote both horizontal integration across basic science disciplines and units, and vertical integration with clinical medicine   Regardless of the purpose or context of testing, you should strive to write questions that assess application of basic and clinical science knowledge, rather than recall of isolated facts. General guidelines for writing MCQs for the basic and clinical science Test application of knowledge rather than recall of facts using  vignettes Focus questions on key concepts and principles that are essential information Focus on relevant tasks Test material relevant to learning in clinical clerkships, graduate medical education, and beyond Focus on clinical situations that either occur frequently or are critically important

55. 4.2. Assessing  application of basic science knowledge using   Patient Vignettes  For many (but not all) basic science topics, it is useful to structure MCQs so that the stem consists of a description of a clinical situation – we  term  such stems “patient vignettes.” Structure of a patient vignette The specific information included in the stem varies from vignette to vignette, but the f irst sentence should generally include:         • Age                                          • Gender         • Site of care                                • Presenting complaint(s)         • Duration. This is followed by :         1. History of the chief complaint     2. Associated symptoms         3.Family history (if relevant)           4. Physical findings         5. Results of diagnostic studies         6. and/or the patient’s response to initial treatment

56. 4.2.1.Templates  to assess application of basic science knowledge You will have noticed already that we advocate consistent design in MCQs. Accordingly, there are various templates that you can use to structure your MCQs for a variety of different purposes The next screen will provide  some more   templets to  assess application of basic science knowledge along with an example of a vignette.

57. Templates for assessing application of basic  science knowledge 

58. 4.3.Assessing application of clinical science knowledge  More typically, patients first describe their symptoms and history, and physicians elicit, interpret, and integrate the information (sorting contributory from incidental) and make some type of clinical decision (test, treat, reassure) based on the clinical picture. you can read two approaches to testing clinical sciences( We recommend that writers use this type of approach (Question  2) to writing : think first of a presenting problem around which a clinical vignette can be constructed.

59. 4.3.1.Writing clinical  Vignettes: Vignette  Worksheet and Templets T he vast majority of your MCQs in clinical sciences are best written in the form of a clinical vignette, as follows on the templet 

60. 4.3.2.Writing clinical  Vignettes: Vignette  Worksheet and Templets The example below shows how the vignette worksheet is used as the basis of the patient vignette. Look at the information assembled in the worksheet

61. Based on the information given in table, write the patient vignette in the space that provided. Stem Lead-in Option set Stem: A 47-year-old man is brought to the emergency department 2 hours after the sudden onset of shortness of breath, severe chest pain, and sweating. He has no history of similar symptoms. He has hypertension treated with hydrochlorothiazide. He has smoked one pack of cigarettes daily for 30 years. His pulse is 110/min, respirations are 24/min, and blood pressure is 110/50 mm Hg. A grade 3/6, diastolic blowing murmur is heard over the left sternal border and radiates to the right sternal border. Femoral pulses are decreased bilaterally. An ECG shows left ventricular hypertrophy. Lead -in : Which of the following is the most likely diagnosis? Option Set A. Acute myocardial infarction B. Aortic dissection C. Oesophageal rupture D. Mitral valve prolapse E. Pulmonary embolism

62. 4.3.3.Some more templates for you

63. Diagnosis template

64. Diagnostic studies template

65. Mechanism template 

66. Final course assessment  You have successfully completed the course Remember ! Completing the e-course is necessary but not sufficient for  certification to be an item writer   You are  required to  complete the following  tasks  and submit your  work  for the resposible body Activity Write a well-structure   MCQs for  basic  and clinical sciences to assess application of knowlodge using the templates provided  One well-structured MCQ in each types of templets (i.e.) 5 MCQ using clinical viginetts ( one in each type of template) 6 MCQ using basic science template(one each type of template) Plagarism is totally unacceptable and  will be checked  using a sofware Write the question by your own using a variety of resources  GOOD LUCK