Recap of the OMED Presentation on The Continuing Quest for the Elusive Perfect Multiple Choice Questions (MCQ) by The NBOME

Nov 9, 2014 by Medical Education Rep

Written by Harika Kantamneni, Danielle Maholtz and The COSGP Medical Education Committee

The NBOME’s mission is to protect the public by providing means to assess competencies for osteopathic medicine and related health care professions

NBOME began identifying question topics by first identifying key domains and competencies for future osteopathic general physicians

Blueprints of these can be found here

About 40% of written and submitted questions make it past the approval and editing process to become used as actual test questions

COMLEX Level 1 focuses more on understanding the basis of medicine and COMLEX Level 2 is more focused on understanding patient management

Miller’s Triangle Hierarchy:

Miller's Triangle
Item Architecture

  • Item Stem composed of a Clinical Scenario (bulk of an item) with a Lead In –
    • Clinical Scenario – the first sentence summaries the who, what where, when and why followed by relevant historical information and physical findings
    • Lead In serves as a connector between the clinical scenario and the answer options
  • Answer Options composed of both an Answer Key (correct option) and Distractors

Steps to write a question

  • Define the concept to test
  • Develop the scenario
  • Write the lead-in
  • Identify the key and design the distractors

Requirements for every item submitted to the NBOME

  • Item Concept that is non-controversial and requires high-order thinking on a high-impact element of a topic
  • Clinical Scenario
  • Lead-In
  • Answer Options
  • Reference that is a current and NBOME recognized source
  • Media (if applicable)

Questions must require reading of the scenario and lead-in for the item to be answered, but should be able to be answered prior to looking at the answer options

Bad Lead-Ins are avoided, where an item has a vague and unfocused lead-in, which forces the examinee to guess the objective of the item and therefore negates the concept being tested in the exam

The NBOME doesn’t use phrases/clues unnecessarily

Distractors highlight the understudying students through common misconceptions , faulty logic , content associated with the items in the questions

Bad answer choices

  • Paired Options – two options that are visually similar, are closely related or are complete opposites
  • Overlapping options – when two or more answer options coincide
  • Word repeats – the presence of a term in the key that matches a term used in the stem
  • Incongruous options – one or more option(s) that stand out from the others in terms of length, specificity or classifications

Key Takeaways on Question Preparation

  • Draw examination content from your content outline or blueprint 
  • Define meaningful item concepts Use content that requires examinees to interpret it 
  • Write lead-ins that are clear and focused and require reading the scenario 
  • Select attractive, plausible distractors

AOA Career Compass Competition

Oct 28, 2014 by Medical Education Rep

The COSGP Medical Education Committee would like to announce their AOA Career Compass Competition! Starting today, 10/28 we are asking the students at each COM to donate resources to the AOA Career Compass. The COSGP Representatives from your school should reach out to you to gather a list of the topics you share. This is a wonderful resource developed by the AOA to allow students, interns, residents and physicians to share advice and information with one another, organized so it is shared with those who need it when they need it. The competition will end at the beginning of January, prior to the next COSGP meeting at Campbell. The school with the most resources of the best quality will win, so please participate!




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National Board of Osteopathic Medical Examiners
National Board of Osteopathic Medical Examiners

Visit NBOME for up-to-date information on the COMLEX-USA such as details about the examination, testing dates and score converters to determine a percentile for your results.

Single GME Accreditation System

AACOM, the AOA, and the ACGME approved an agreement that will result in a single accreditation system for graduate medical education by June 30, 2020.

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