The Prevalence of Item Construction Flaws in Medical School Examinations and Innovative Recommendations for Improvement

*Kenneth D. Royal,1,2 Mari-Wells Hedgpeth1

1. Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, North Carolina, USA
2. Department of Family Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA
*Correspondence to

Disclosure: The authors have declared no conflicts of interest.
Received: 16.08.16 Accepted: 27.09.16
Citation: EMJ Innov. 2017;1[1]:61-66.


The purpose of this study was to calculate the prevalence and nature of item construction flaws within one large medical school and to identify several innovative approaches that may serve as potential remedies for these problems. Results indicated that approximately one in five items contained a construction flaw, with the overwhelming majority of flaws involving poor quality distractors. A series of innovative recommendations are presented, including modern psychometric analytical techniques to more thoroughly inspect data, item manipulation techniques, and the use of innovative item types that may alleviate the need for distractors altogether.

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