Academic journal article American Journal of Pharmaceutical Education

Best Practices Related to Examination Item Construction and Post-Hoc Review

Academic journal article American Journal of Pharmaceutical Education

Best Practices Related to Examination Item Construction and Post-Hoc Review

Article excerpt


The primary goal of assessment via examination is to accurately measure student achievement of desired knowledge and competencies, which are generally articulated through learning objectives. (1,2) For students, locally developed examinations convey educational concepts and topics deemed important by faculty members, which allows students to interact with those concepts and receive feedback on the extent to which they have mastered the material. (3,4) For faculty members, results provide valuable insight into how students are thinking about concepts, assist with identifying student misconceptions, and often serve as the basis for assigning course grades.

Furthermore, examinations allow faculty members to evaluate student achievement of learning objectives to make informed decisions regarding the future use and revision of instructional modalities. (5,6)

Written examinations may be effective assessment tools if designed to measure student achievement of the desired competencies in an effective manner. Quality items (questions) are necessary for an examination to have reliability and to draw valid conclusions from the resulting scores. (7,8) Broadly defined, reliability refers to the extent to which an examination or another assessment leads to consistent and reproducible results, and validity pertains to whether the examination score provides an accurate measure of student achievement for the intended construct (eg, knowledge or skill domain). (9,10) However, development of quality examination items, notably multiple choice, can be challenging; existing evidence suggests that a sizeable proportion of items within course-based examinations contain one or more flaws. (7,11) While there are numerous published resources regarding examination and item development, most appear to be aimed towards those with considerable expertise or significant interest in the subject, such as scholars in educational psychology or related disciplines. (2,8-11) Our goal in authoring this manuscript was to provide an accessible primer on test item development for pharmacy and other health professions faculty members. As such, this commentary discusses published best practices and guidelines for test item development, including different item types and the advantages and disadvantages of each, item analysis for item improvement, and best practices for examination score adjustments. A thorough discussion of overarching concepts and principles related to examination content development, administration, and student feedback is contained in the companion commentary article, "Best Practices on Examination Construction, Administration, and Feedback." (12)

General Considerations Before Writing Examination Items

Planning is essential to the development of a well-designed examination. Before writing examination items, faculty members should first consider the purpose of the examination (eg, formative or summative assessment) and the learning objectives to be assessed. One systematic approach is the creation of a detailed blueprint that outlines the desired content and skills to be assessed as well as the representation and intended level(s) of student cognition for each. (12) This will help to determine not only the content and number of items but also the types of items that will be most appropriate. (13,14) Moreover, it is important to consider the level of student experience with desired item formats, as this can impact performance. (15) Students should be able to demonstrate what they have learned, and performance should not be predicated upon their ability to understand how to complete each item. (16) A student should be given formative opportunities to gain practice and experience with various item formats before encountering them on summative examinations, This will enable students to self-identify any test-taking deficiencies and could help to reduce test anxiety. (17) Table 1 contains several recommendations for writing quality items and avoiding technical flaws. …

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