Guide to creating board review questions

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

1. Go to the home page on WikiDoc, and click on the icon that says, "Board Review", or click here.
2. Click on the icon that says "Click here to add questions".
3. Type in your name in the Author Box
4. Select the Exam Type
5. Categories for the question will appear. Check off ONE main category, and the appropriate subcategory
6. Introduce an Overall Explanation into the Box focusing on the correct answer choice
7. Use the remaining boxes to type in the answers to the questions and the explanations for each of the answers.
8. Select "Reviewed" if WBR Team has reviewed and approved the question. Click here to see the WBR checklist
9. Add an image if you would like
10. 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”.

Answers

• 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 Explanation

• The questions should include detailed explanation that provides the following:
  • The reason why the correct answer is correct
  • The reason why each of the distractors is incorrect
• These questions are intended to teach rather than to test, hence the use of graphics, references and guidelines is encouraged when applicable.

References

References should be included when possible linking to new articles, review articles or guidelines that serve the initial teaching goal of the questions.

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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Other Wiki Links

• MCAT
• USMLE Step 1
• USMLE Step 2-CK
• USMLE Step 2 Clinical Skills
• USMLE Step 3
• COMLEX-USA

Other External Links

• http://www.usmle.org/pdfs/step-1/2013content_step1.pdf
• http://www.usmle.org/pdfs/step-2-ck/2012--13_FINAL_S2_GSI.pdf
• http://www.usmle.org/pdfs/step-3/2013content_step3.pdf
• http://www.nbme.org/
• http://www.nbome.org/
• http://www.ecfmg.org/
• http://www.osteopathic.org/Pages/default.aspx