Multiple choice, multiple choice question (MCQ), or objective response is a form of an objective assessment in which respondents are asked to select only the correct answer from the choices offered as a list. The multiple choice format is most frequently used in educational testing, in market research, and in elections, when a person chooses between multiple candidates, parties, or policies. Although E. L. Thorndike developed an early scientific approach to testing students, it was his assistant Benjamin D. Wood who developed the multiple-choice test. Multiple-choice testing increased in popularity in the mid-20th century when scanners and data-processing machines were developed to check the result. Christopher P. Sole created the first multiple-choice examinations for computers on a Sharp Mz 80 computer in 1982.
Nomenclature Single best answer or one best answer is a written examination form of multiple choice question used extensively in medical education. This form, from which the candidate must choose the best answer, has been distinguished from single correct answer forms, which can produce confusion where more than one of the possible answers has some validity. The single best answer form makes it explicit that more than one answer may have elements that are correct, but that one answer will be superior. Another type of MCQ also used in medical education is the extended matching question (EMQ). EMQs have been designed to test clinical reasoning and applied knowledge rather than simple recall. A comparison study found that students preferred the MCQ exam format, but that EMQs tested and delivered content better.
Structure
Multiple choice items consist of a stem and several alternative answers. The stem is the opening—a problem to be solved, a question asked, or an incomplete statement to be completed. The options are the possible answers that the examinee can choose from, with the correct answer called the key and the incorrect answers called distractors. Only one answer may be keyed as correct. This contrasts with multiple response items in which more than one answer may be keyed as correct. Usually, a correct answer earns a set number of points toward the total mark, and an incorrect answer earns nothing. However, tests may also award partial credit for unanswered questions or penalize students for incorrect answers, to discourage guessing. For example, the SAT Subject tests remove a quarter-point from the test taker's score for an incorrect answer. For advanced items, such as an applied knowledge item, the stem can consist of multiple parts. The stem can include extended or ancillary material such as a vignette, a case study, a graph, a table, or a detailed description which has multiple elements to it. Anything may be included as long as it is necessary to ensure the utmost validity and authenticity to the item. The stem ends with a lead-in question explaining how the respondent must answer. In a medical multiple choice items, a lead-in question may ask "What is the most likely diagnosis?" or "What pathogen is the most likely cause?" in reference to a case study that was previously presented. The items of a multiple choice test are often colloquially referred to as "questions", but this is a misnomer because many items are not phrased as questions. For example, they can be presented as incomplete statements, analogies, or mathematical equations. Thus, the more general term "item" is a more appropriate label. Items are stored in an item bank.
Examples Ideally, the multiple choice question should be asked as a "stem", with plausible options, for example:
(The correct answers are B, C and A respectively.) A well written multiple-choice question avoids obviously wrong or implausible distractors (such as the non-Indian city of Detroit being included in the third example), so that the question makes sense when read with each of the distractors as well as with the correct answer. A more difficult and well-written multiple choice question is as follows:
Advantages There are several advantages to multiple choice tests. If item writers are well trained and items are quality assured, it can be a very effective assessment technique. If students are instructed on the way in which the item format works and myths surrounding the tests are corrected, they will perform better on the test. On many assessments, reliability has been shown to improve with larger numbers of items on a test, and with good sampling and care over case specificity, overall test reliability can be further increased. Multiple choice tests often require less time to administer for a given amount of material than would tests requiring written responses. Multiple choice questions lend themselves to the development of objective assessment items, but without author training, questions can be subjective in nature. Because this style of test does not require a teacher to interpret answers, test-takers are graded purely on their selections, creating a lower likelihood of teacher bias in the results. Factors irrelevant to the assessed material (such as handwriting and clarity of presentation) do not come into play in a multiple-choice assessment, and so the candidate is graded purely on their knowledge of the topic. Finally, if test-takers are aware of how to use answer sheets or online examination tick boxes, their responses can be relied upon with clarity. Overall, multiple choice tests are the strongest predictors of overall student performance compared with other forms of evaluations, such as in-class participation, case exams, written assignments, and simulation games. Prior to the widespread introduction of single best answer into medical education, the typical form of examination was true-false questions. But during the 2000s, educators found that single best answers would be superior.
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