ABIM Question Writing Guidelines

The multiple-choice question (MCQ) typically consists of text that provides the information required to present a problem (the "stem"), the question itself ("lead line"), and, finally, by a list of options (one correct answer and "distractors") from which the examinee chooses a response. The Board strongly encourages development of patient-based questions; in other words, questions relating to clinical scenarios. A good MCQ contains medical content presented in such a way that the candidate who possesses the required knowledge will be able to answer the question correctly; the candidate who does not possess this knowledge will be unable to do so. Correct answers must be absolutely correct. Incorrect answers should look correct to the less knowledgeable candidate. Questions should not be tricky or overly difficult; rather, they should focus on assessing the examinee's ability to provide excellent care to patients. Consider asking yourself about each question, "Is this material that a general internist or subspecialist in practice must recall daily, weekly, monthly once a year, or perhaps once in a lifetime?" Less frequently used information still is important if it deals with potentially life- or function-threatening conditions or important management decisions.

All ABIM examinations contain only A-type (single-best-answer) questions. The use of only A-types (1) simplifies and increases the efficiency of examination development, (2) simplifies examination administration and scoring. (3) makes candidate scores and feedback more meaningful and understandable, and (4) increases the proportion of questions assessing synthesis and clinical judgment, which enhances examination relevance and validity.