Guide to creating board review questions: Difference between revisions
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==Design of the Questions== | ==Design of the Questions== | ||
===Stem of the Question=== | |||
*The questions are preferred to be narrated as a clinical vignette that is not an actual case. | *The questions are preferred to be narrated as a clinical vignette that is not an actual case. | ||
*The information as well as the illustrations should serve the testing point. | *The information as well as the illustrations should serve the testing point. | ||
| Line 48: | Line 48: | ||
* The questions should not include negative phrasing , for example “except” or “not”. | * The questions should not include negative phrasing , for example “except” or “not”. | ||
=== | ===Answer Choices=== | ||
* Answers should include five choices where one answer is correct and the other four answers are distractors. | * Answers should include five choices where one answer is correct and the other four answers are distractors. | ||
* Answers should not be "true" or "false". | * Answers should not be "true" or "false". | ||
| Line 56: | Line 56: | ||
* “None of the above”, “All of the above” or some combination of response must not be used. | * “None of the above”, “All of the above” or some combination of response must not be used. | ||
===Answer Explanations=== | |||
* These questions are intended to teach rather than to test, hence the use of graphics, references and guidelines is encouraged when applicable. | * These questions are intended to teach rather than to test, hence the use of graphics, references and guidelines is encouraged when applicable. | ||
===Overall Explanation=== | ====Overall Explanation==== | ||
Only ONE answer is the best or the most appropriate one | Only ONE answer is the best or the most appropriate one | ||
Justify why that choice is correct: explain the pertinent positive findings, not just list the topic. (i.e. the patient has this symptom which is a typical presentation of this disease). Explain also the pertinent negatives. | Justify why that choice is correct: explain the pertinent positive findings, not just list the topic. (i.e. the patient has this symptom which is a typical presentation of this disease). Explain also the pertinent negatives. | ||
===Answer Choice Explanation=== | ====Individual Answer Choice Explanation==== | ||
* Include why the correct answer is correct and why the each of the distractors are incorrect | * Include why the correct answer is correct and why the each of the distractors are incorrect | ||
* Include concise, yet thorough explanation providing a high yield information | * Include concise, yet thorough explanation providing a high yield information | ||
* Add additional information to the correct answer explanation, not explained on the overall explanation. | * Add additional information to the correct answer explanation, not explained on the overall explanation. | ||
===Educational Objective=== | ====Educational Objective==== | ||
*Include short high yield fact at the end of the explanation (1 or 2 take-home sentences/phrases) | *Include short high yield fact at the end of the explanation (1 or 2 take-home sentences/phrases) | ||
==References== | |||
References should be included when possible linking to new articles, review articles or guidelines that serve the initial teaching goal of the questions. | References should be included when possible linking to new articles, review articles or guidelines that serve the initial teaching goal of the questions. | ||
===Internal resources=== | |||
*Use the Wikidoc.org content | *Use the Wikidoc.org content | ||
*Promote Wikidoc use inserting internal links into the explanations | *Promote Wikidoc use inserting internal links into the explanations | ||
===External resources=== | |||
Mention external sources used if you their content is used to respect Copy Rights. | Mention external sources used if you their content is used to respect Copy Rights. | ||
-Books | -Books | ||
| Line 83: | Line 83: | ||
*Master The Boards for Step 2CK and Step3 | *Master The Boards for Step 2CK and Step3 | ||
*Med-Essentials For Step1 | *Med-Essentials For Step1 | ||
===Websites=== | |||
* [http://www.usmle-forums.com www.usmle-forums.com] | * [http://www.usmle-forums.com www.usmle-forums.com] | ||
-Recent test takers give feedback about their experience and commonly tested facts. Updated constantly. | -Recent test takers give feedback about their experience and commonly tested facts. Updated constantly. | ||
Revision as of 21:37, 2 August 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Gonzalo A. Romero, M.D. [2]
Overview
There are various medical board examinations for which people use questions similar to those seen on the exam, to practice for the exam. In general, questions alone are not sufficient to study for an exam. They are a supplemental tool to test ones knowledge, and help to solidify what they have learned.
Description
The aim of the questions is to teach rather than to test. The cognitive tasks that the questions should target can be one or more of the following:
- Making a diagnosis
- Ordering diagnostic tests
- Ordering treatment
- Identifying risk
- Interpreting data
- Recommending patient management
- Identifying clinical features
- Recognizing pathology
Wiki Board Review
The Wiki Doc Board Review aims to help test takers towards their exam preparation. On this section the user can access several Board Review Questions at different levels. They include USMLE Step 1, USMLE Step 2 Clinical Knowledge (CK), USMLE Step 3, MCAT and BOARD Certification.
This guide is geared towards editors who want to create and add questions contributing to the WBR Questions Pool.
Adding a Question Step by Step
- Go to the home page on WikiDoc, and click on the icon that says, "Board Review", or click here.
- Click on the icon that says "Click here to add questions".
- Type in your name in the Author Box
- Select the Exam Type
- Categories for the question will appear. Check off ONE main category, and the appropriate subcategory
- Introduce an Overall Explanation into the Box focusing on the correct answer choice
- Use the remaining boxes to type in the answers to the questions and the explanations for each of the answers.
- Select "Reviewed" if WBR Team has reviewed and approved the question. Click here to see the WBR checklist
- Add an image if you would like
- For more information about a question format click here here.
CONGRATULATIONS! You just created a Question!
Design of the Questions
Stem of the Question
- The questions are preferred to be narrated as a clinical vignette that is not an actual case.
- The information as well as the illustrations should serve the testing point.
- Below are some of the information that can be found in a question. They should be orderly included as follows:
- Age, Gender (e.g., a 70 year-old man)
- Site of Care (e.g., comes to the emergency department)
- Duration (e.g. that has started one week ago)
- Significant Patient History
- Significant Family History
- Significant Diagnostic Studies or the Results of Diagnostic Studies
- Try as much as possible to include images whether still or motion
- Initial Treatment and Response
- The questions should not include negative phrasing , for example “except” or “not”.
Answer Choices
- Answers should include five choices where one answer is correct and the other four answers are distractors.
- Answers should not be "true" or "false".
- All distractors should be homogeneous as they should fall in the same category as the correct answer and should me similar in length.
- Long correct answers are discouraged.
- Illogical answers, absolute terms, word repeats ( for example: a word or phrase in the correct response is the same as in the stem) are discouraged.
- “None of the above”, “All of the above” or some combination of response must not be used.
Answer Explanations
- These questions are intended to teach rather than to test, hence the use of graphics, references and guidelines is encouraged when applicable.
Overall Explanation
Only ONE answer is the best or the most appropriate one Justify why that choice is correct: explain the pertinent positive findings, not just list the topic. (i.e. the patient has this symptom which is a typical presentation of this disease). Explain also the pertinent negatives.
Individual Answer Choice Explanation
- Include why the correct answer is correct and why the each of the distractors are incorrect
- Include concise, yet thorough explanation providing a high yield information
- Add additional information to the correct answer explanation, not explained on the overall explanation.
Educational Objective
- Include short high yield fact at the end of the explanation (1 or 2 take-home sentences/phrases)
References
References should be included when possible linking to new articles, review articles or guidelines that serve the initial teaching goal of the questions.
Internal resources
- Use the Wikidoc.org content
- Promote Wikidoc use inserting internal links into the explanations
External resources
Mention external sources used if you their content is used to respect Copy Rights. -Books
- First Aid latest edition for STEP 1, updated yearly by students who aced the exam
- First Aid for Step 2CK, updated biyearly
- Master The Boards for Step 2CK and Step3
- Med-Essentials For Step1
Websites
-Recent test takers give feedback about their experience and commonly tested facts. Updated constantly.
Tips to Build Questions
- Read and understand the tested material to grasp basic principles, diagnostic approach, management and therapeutics according to the BOARD level.
- Get familiar with the format, content and high Yield material. Take many exams using the NBME website [[[3]]], other Qbanks and the actual exam, when ready. Respect Copy Rights sources from Qbanks.
- Pick a specific content
- Use WikiDoc to obtain information, pictures, videos, and links on the explanations.
- Do not give away the correct answer. Challenge the test taker! Avoid using proper or specific signs. Describe signs and symptoms in lay terms to give the hints. Example: instead of “marfanoid habitus” describe the patient with long extremities, skinny appearance and tall.
- Do not ask negatively i.e. "which of the following is incorrect, not correct or false?".
- Long stems help recreate the challenge on test date. Short and moderate stems test specific facts.
Multi-step Questions
Test the process, not the content including 2 ot 3 Step questions.
- Symptoms or clinical presentation
- Physical exam findings
- Laboratory findings
- Diagnosis
- Treatment of Choice
- Mechanism of action of treatment of choice
- Most common adverse effect
Example
Micro questions require the reader to make a diagnosis, know the correct drug and then the mechanism of action of the drug (3 steps). An equally difficult but less elegant question would ask what HLA-subtype is associated with some rare rheumatological disease.
Matching Sets
The format remains the same as above, but it tests two or three different concepts on separate questions having the same clinical vignette.
USMLE Step 1 Question Format
Test the basic principles using graphs, diagrams, pictures, calculations, clinical scenarios/cases, and multimedia Revise vignettes and ask something different
USMLE Step 2CK Question Format
- Follow the most recent Algorithms/Guidelines from the Wiki
- Useful Resources are Master the Boards First Aid for Step 2 CK
- Include basic STEP 1 questions; 50-60% of the knowledge from Step 2CK comes from Step 1
- Include Labs
- Long stems
- Accommodate information within the vignette that will benefit the test taker to identify the proper answer choice
- Include extra information that is not necessary leading towards the correct answer
- Audio and video questions would be ideal also
Case Scenarios
- Age of patient
- Sex
- Chief complaint
- Vitals
- Describe the chief complaint
- Physical examination findings
- Significant past history if any
- Laboratory findings
- Image or video (if applicable)
Commonly Asked Questions
- What is the most likely diagnosis?
- What is the most likely cause for this condition?
- What is the next best step in management?
- What is the best initial treatment?
- What is the best treatment for this condition?
- What is the best/ most accurate laboratory test to confirm diagnosis?
- What is the drug of choice to treat this condition?
- What is the most likely physical exam finding? (eg. On auscultation, abdominal examination, etc.)
- Which of the following is the most likely underlying mechanism?
- What is the most common risk factor for this condition?
- What is the most common complication of this condition?
- What is the best drug/ drug of choice used to treat this condition?
USMLE Step 3 Question Format
Testing mainly on management of case, covering the following fields:
Application of Concepts
- What is the most likely cause for this condition?
- What is the most likely underlying mechanism?
- What is the cause of (sign/ physical exam finding)?
- Questions related to research studies
History and Physical Examination
- What is the most likely physical exam finding?
- What facts from the past history are important for diagnosis?
- What is the most common risk factor for this condition?
Laboratory and Diagnostic Studies
- What is the most appropriate/accurate laboratory test to evaluate this patient?
- What is the most appropriate laboratory test to evaluate the efficacy of current treatment?
- What is the best initial laboratory test to order?
- What is the most likely result of this laboratory test seen in this condition?
- What is the most likely laboratory finding seen in this condition?
Diagnosis
- What is the most likely diagnosis?
- Which condition is most commonly associated with ____?
Prognosis
- Which of the following factors influences prognosis (good or bad)?
- Which of the following is the best/ worst prognostic indicator?
- Which of the following laboratory finding indicates best/ worst prognosis?
- After follow-up, which of the following is the most common factor that indicates favorable prognosis?
- What is the most appropriate counseling advice?
- What is the most common complication of this condition?
- What is the most likely outcome of this condition?
Management
- What is the next best step in management of this patient?
- What is the most appropriate screening test?
- What is the most appropriate preventive measure for this condition?
- What is the best initial treatment?
- What is the most accurate treatment?What is the best drug/ drug of choice used to treat this condition?
- What is the most appropriate discharge plan?
- Which drug is contraindicated in the treatment of this condition?
- Which of the following is a contraindication for the use of this drug?
- What is the most likely adverse effect of this drug?
Ethics and Principles
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